Provider Demographics
NPI:1053098459
Name:ALS MILLERSBURG GREENRIDGE, INC
Entity type:Organization
Organization Name:ALS MILLERSBURG GREENRIDGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-350-9095
Mailing Address - Street 1:125 PUTNAM ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2952
Mailing Address - Country:US
Mailing Address - Phone:740-415-1138
Mailing Address - Fax:201-661-2846
Practice Address - Street 1:1405 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-7920
Practice Address - Country:US
Practice Address - Phone:330-674-1026
Practice Address - Fax:201-661-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility