Organization
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Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE R MILLER RN BSN (CEO)
(330) 850-5275
Entity
Organization
Contact information
Practice address
677 S DIAMOND ST, RAVENNA, OH 44266-2877
(330) 850-5275
(330) 578-9064
Mailing address
677 S DIAMOND ST, RAVENNA, OH 44266-2877
(330) 850-5275
(330) 578-9064
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
Primary
6704865
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119414
—
OH
Enumeration date
08/03/2016
Last updated
05/20/2019
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