Provider Demographics
NPI:1699987867
Name:DRIFTWOOD INDUSTRIES LLC
Entity type:Organization
Organization Name:DRIFTWOOD INDUSTRIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER III
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-466-1818
Mailing Address - Street 1:185 WATER ST.
Mailing Address - Street 2:PO BOX 69
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041
Mailing Address - Country:US
Mailing Address - Phone:440-466-1818
Mailing Address - Fax:440-466-5212
Practice Address - Street 1:185 WATER ST.
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041
Practice Address - Country:US
Practice Address - Phone:440-466-1818
Practice Address - Fax:440-466-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0400720251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2716494Medicaid