Provider Demographics
NPI:1861851321
Name:THE LUTHERAN VILLAGE AT MILLER'S GRANT, INC.
Entity Type:Organization
Organization Name:THE LUTHERAN VILLAGE AT MILLER'S GRANT, INC.
Other - Org Name:THE LUTHERAN VILLAGE AT MILLER'S GRANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-848-0090
Mailing Address - Street 1:9000 FATHERS LEGACY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3713
Mailing Address - Country:US
Mailing Address - Phone:410-696-6700
Mailing Address - Fax:
Practice Address - Street 1:9000 FATHERS LEGACY
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042
Practice Address - Country:US
Practice Address - Phone:410-696-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility