Organization
KINGSTON OF MIAMISBURG, LLC
Active
Other names
Kingston Of Miamisburg
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY NIRSCHL (TREASURER)
(419) 247-2824
Entity
Organization
Contact information
Practice address
1120 DUNAWAY ST, MIAMISBURG, OH 45342-3839
(937) 866-9089
(937) 866-6907
Mailing address
PO BOX 2165, TOLEDO, OH 43603-2165
(419) 247-2880
(419) 247-2872
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1613N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000003059
ANTHEM BC/BS
OH
05
—
2611212
—
OH
Enumeration date
10/03/2005
Last updated
08/22/2020
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