MEDICARE: MILLER HOLDINGS ALLIANCE, 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	:	1891917100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLER HOLDINGS ALLIANCE, INC.

Provider Business Mailing Address
First Line	:	2460 ELM RD NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-2900
Country	:	US
Telephone Number	:	330-308-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	2714 BEECHWOOD AVE
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-4437
Country	:	US
Telephone Number	:	330-821-0071
Fax Number	:	330-821-8871

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	01/29/2013

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