Organization
MIAMI SHORES OF MORAINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA HEERMANS (ADMINISTRATOR)
(937) 268-3488
Entity
Organization
Contact information
Practice address
3421 PINNACLE RD, DAYTON, OH 45418-2918
(937) 268-3488
(937) 267-5021
Mailing address
3421 PINNACLE RD, DAYTON, OH 45418-2918
(937) 268-3488
(937) 267-5021
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1723-NH
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2358112
—
OH
Enumeration date
08/19/2005
Last updated
02/25/2008
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