Provider Demographics
NPI:1679974034
Name:MILLBOURN CNP, INC
Entity Type:Organization
Organization Name:MILLBOURN CNP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:937-638-9468
Mailing Address - Street 1:17978 SHARP RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-9229
Mailing Address - Country:US
Mailing Address - Phone:937-638-9468
Mailing Address - Fax:419-331-2205
Practice Address - Street 1:2440 BATON ROUGE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-5104
Practice Address - Country:US
Practice Address - Phone:419-331-2273
Practice Address - Fax:419-331-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA14504NP261QH0100X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service