Provider Demographics
NPI:1760161392
Name:MIDDLEBURG HEIGHTS ALF OPERATIONS
Entity Type:Organization
Organization Name:MIDDLEBURG HEIGHTS ALF OPERATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-425-4218
Mailing Address - Street 1:160 MERCER ST APT 104
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4277
Mailing Address - Country:US
Mailing Address - Phone:614-425-4218
Mailing Address - Fax:
Practice Address - Street 1:15435 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4827
Practice Address - Country:US
Practice Address - Phone:440-887-1125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility