Healthcare Provider Details

I. General information

NPI: 1518131663
Provider Name (Legal Business Name): MILLIE'S CENTER L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2008
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HUDSON ST
SILVER CITY NM
88061-5437
US

IV. Provider business mailing address

600 N HUDSON ST
SILVER CITY NM
88061-5437
US

V. Phone/Fax

Practice location:
  • Phone: 575-534-9172
  • Fax:
Mailing address:
  • Phone: 575-534-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberCU00010017
License Number StateNM

VIII. Authorized Official

Name: CHARLOTTE MCGAUGHEY
Title or Position: TREASURER
Credential: CPA
Phone: 575-590-0946