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General NPI Number Information
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NPI Number | 1235228016
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Entity Type | Organization
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Legal Business Name | D MILLER INNOVATIVE CARE INC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 902 W MEFFORD STREET
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City | ROBINSON
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State | IL
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Zip | 62454
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Country | US
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Telephone | 618-546-5638
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Fax | 618-544-7068
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Provider Business Mailing Address
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Address Line | PO BOX 192 902 W MEFFORD STREET
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City | ROBINSON
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State | IL
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Zip | 62454
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Country | US
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Telephone | 618-546-5638
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Fax | 618-544-7068
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Authorized Official
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Title or Position | ADMINISTRATOR OWNER
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Name | MR. DWIGHT L MILLER
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Credential |
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Telephone | 618-546-5638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0029645
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License Number State | IL
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