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General NPI Number Information
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NPI Number | 1225511157
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Entity Type | Organization
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Legal Business Name | MILLER & MOSS AFC
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 3638 IRENE ST
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City | INKSTER
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State | MI
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Zip | 48141-2127
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Country | US
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Telephone | 734-405-0846
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Fax | 734-895-8873
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Provider Business Mailing Address
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Address Line | 3409 IRENE ST
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City | INKSTER
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State | MI
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Zip | 48141-2124
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Country | US
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Telephone | 734-721-9630
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Fax | 734-895-8873
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CHARISE MUHAMMAD
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Credential |
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Telephone | 313-758-8075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AS820295801
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | AS820295801
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License Number State | MI
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