MEDICARE: MILLER HOLDINGS SUMMIT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1346778107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLER HOLDINGS SUMMIT, INC.

Provider Business Mailing Address
First Line	:	2460 ELM RD NE STE 600
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-2949
Country	:	US
Telephone Number	:	330-307-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	3568 E WATERLOO RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-4112
Country	:	US
Telephone Number	:	330-628-5885
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KURT MILLER
Credential	:
Telephone Number	:	330-307-6816

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	05/24/2017

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