Provider Demographics
NPI:1922336239
Name:MILLER HOLDINGS BROADFIELD, INC.
Entity Type:Organization
Organization Name:MILLER HOLDINGS BROADFIELD, INC.
Other - Org Name:BROADFIELD CARE CENTER
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 1:7927 MIDDLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3023
Practice Address - Country:US
Practice Address - Phone:440-466-3702
Practice Address - Fax:440-466-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0268315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36G076Medicare Oscar/Certification