Basic Information
| Provider Information | |||||||||
| NPI: | 1376534610 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MILAN SKILLED NURSING, LLC | ||||||||
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| OtherOrganizationName: | CONTINUING HEALTHCARE OF MILAN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7261 ENGLE RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441308467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167721105 | ||||||||
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| Practice Location | |||||||||
| Address1: | 185 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MILAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448469765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194992576 | ||||||||
| FaxNumber: | 4194994577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | PARSONS | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 2167721105 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 5359 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1881778843 | 01 | MEDICARE DME NPI | OTHER | 2052095 | 05 | OH | MEDICAID | 341893522 | 01 | OH | FEDERAL ID NUMBER-MANAGER | OTHER |