Healthcare Provider Details

I. General information

NPI: 1144949934
Provider Name (Legal Business Name): MILESTONE SUPPORTIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13581 W YOUNG ST
SURPRISE AZ
85374-5415
US

IV. Provider business mailing address

13581 W YOUNG ST
SURPRISE AZ
85374-5415
US

V. Phone/Fax

Practice location:
  • Phone: 602-402-5946
  • Fax:
Mailing address:
  • Phone: 602-402-5946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ERICA MOON
Title or Position: CEO
Credential:
Phone: 602-402-5946