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General NPI Number Information
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NPI Number | 1114815966
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Entity Type | Organization
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Legal Business Name | GRACE MILLER
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 486 W PEACH TREE DR
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City | HAYDEN
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State | ID
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Zip | 83835-9740
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Country | US
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Telephone | 208-660-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 486 W PEACH TREE DR
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City | HAYDEN
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State | ID
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Zip | 83835-9740
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Country | US
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Telephone | 208-660-2368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GRACE MILLER
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Credential |
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Telephone | 208-660-2368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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