Healthcare Provider Details

I. General information

NPI: 1922091834
Provider Name (Legal Business Name): MILLER MEMORIAL COMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BROAD ST
MERIDEN CT
06450-5843
US

IV. Provider business mailing address

360 BROAD ST
MERIDEN CT
06450-5843
US

V. Phone/Fax

Practice location:
  • Phone: 203-237-8815
  • Fax: 203-237-5944
Mailing address:
  • Phone: 203-237-8815
  • Fax: 203-237-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number2242
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2242
License Number StateCT

VIII. Authorized Official

Name: MR. BRANDON M MUNSON
Title or Position: ADMINISTRATOR
Credential: CCO
Phone: 203-237-8815