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General NPI Number Information
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NPI Number | 1275915951
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Entity Type | Organization
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Legal Business Name | MILLER GROUP HOME INC
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 5208 MEGILL ROAD
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City | FARMINGDALE
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State | NJ
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Zip | 07727
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Country | US
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Telephone | 732-938-4376
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Fax | 732-938-9473
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Provider Business Mailing Address
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Address Line | PO BOX 112
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City | FARMINGDALE
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State | NJ
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Zip | 07727-0112
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Country | US
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Telephone | 732-938-4376
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Fax | 732-938-9742
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CLAIR MILLER
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Credential |
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Telephone | 732-938-4376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | GH749
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | GH020
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License Number State | NJ
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