Provider Demographics
NPI:1790852879
Name:MILLER HOLDINGS MAG, INC.
Entity Type:Organization
Organization Name:MILLER HOLDINGS MAG, INC.
Other - Org Name:WOODBINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-307-6816
Mailing Address - Street 1:2460 ELM RD NE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-2900
Mailing Address - Country:US
Mailing Address - Phone:330-307-6816
Mailing Address - Fax:
Practice Address - Street 1:8320 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1313
Practice Address - Country:US
Practice Address - Phone:513-761-4943
Practice Address - Fax:513-821-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0072324Medicaid