Healthcare Provider Details

I. General information

NPI: 1801203781
Provider Name (Legal Business Name): MIAYEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2014
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MIGHTY JOE TRL
YORK SC
29745-2667
US

IV. Provider business mailing address

113 S COLLEGE ST
MONROE NC
28112-5427
US

V. Phone/Fax

Practice location:
  • Phone: 980-333-5551
  • Fax:
Mailing address:
  • Phone: 980-333-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN WOAZEAH JR.
Title or Position: DIRECTOR
Credential: MBA MHP
Phone: 980-333-5551