Miami Shores of Moraine, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1723-NH Issued in OH

Legal business name

MIAMI SHORES OF MORAINE, LLC

Practice address

3421 Pinnacle Rd
Dayton, OH 45418-2918

Phone

(937) 268-3488

Fax

(937) 267-5021

NPI assigned

Aug 19, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lisa Heermans

Title

Administrator

Phone

(937) 268-3488

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1780676205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 PINNACLE RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454182918",
            "telephone_number": "937-268-3488",
            "fax_number": "937-267-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3421 PINNACLE RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454182918",
            "telephone_number": "937-268-3488",
            "fax_number": "937-267-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIAMI SHORES OF MORAINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-19",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "HEERMANS",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "937-268-3488",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "1723-NH",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2358112",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.