Organization
COMPLETE CARE DIVERSIFIED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW M MILLER PT (OWNER / PT)
(419) 873-3488
Entity
Organization
Contact information
Practice address
27511 HOLIDAY LANE, SUITE 105, PERRYSBURG, OH 43551-5315
(419) 873-3488
(419) 873-4777
Mailing address
27511 HOLIDAY LANE, SUITE 105, PERRYSBURG, OH 43551-5315
(419) 873-3488
(419) 873-4777
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
PT012961
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076646
—
OH
Enumeration date
10/02/2013
Last updated
10/02/2013
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