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General NPI Number Information
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NPI Number | 1497963441
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Entity Type | Organization
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Legal Business Name | MILLER RETIREMENT HOME, INC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 11262 SW 56 STREET
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City | MIAMI
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State | FL
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Zip | 33165
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Country | US
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Telephone | 305-412-3633
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Fax | 305-225-1289
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Provider Business Mailing Address
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Address Line | 11262 SW 56 STREET
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City | MIAMI
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State | FL
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Zip | 33165
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Country | US
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Telephone | 305-412-3633
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Fax | 305-225-1289
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Authorized Official
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Title or Position | OWNER
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Name | MARLENE FUENTES
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Credential |
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Telephone | 305-796-8220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL 7498
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License Number State | FL
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