1982158382 NPI number — MILLER HOLDINGS SUNRISE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982158382 NPI number — MILLER HOLDINGS SUNRISE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLER HOLDINGS SUNRISE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982158382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2460 ELM RD NE
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44483-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-307-6816
Provider Business Mailing Address Fax Number:
330-974-1266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38655 SALTWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LISBON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44432-8348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-424-1418
Provider Business Practice Location Address Fax Number:
330-424-3029
Provider Enumeration Date:
08/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
KURT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-307-6816

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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