Provider Demographics
NPI:1790896835
Name:MILLCREST HEALTHCARE GROUP, INC.
Entity Type:Organization
Organization Name:MILLCREST HEALTHCARE GROUP, INC.
Other - Org Name:MILCREST NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ITS VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-292-5706
Mailing Address - Street 1:730 MILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1833
Mailing Address - Country:US
Mailing Address - Phone:937-642-1026
Mailing Address - Fax:937-642-0177
Practice Address - Street 1:730 MILLCREST DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1833
Practice Address - Country:US
Practice Address - Phone:937-642-1026
Practice Address - Fax:937-642-0177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SABER HEALTHCARE HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1361314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2473863Medicaid
OH2473863Medicaid