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General NPI Number Information
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NPI Number | 1649552829
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Entity Type | Organization
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Legal Business Name | MILES CORORATION
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 3959 HIGHWAY 468 W
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City | PEARL
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State | MS
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Zip | 39208-9001
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Country | US
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Telephone | 601-824-4865
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Fax | 601-824-4865
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Provider Business Mailing Address
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Address Line | 108 BAYSHORE DR
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City | RIDGELAND
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State | MS
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Zip | 39157-1129
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Country | US
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Telephone | 601-826-2249
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Fax | 601-824-4865
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Authorized Official
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Title or Position | FOUNDER
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Name | MRS. MARY BATES
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Credential |
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Telephone | 601-826-2249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | N/A
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License Number State | MS
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