=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700819216
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLER HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 FRANKLIN CORNER RD
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08648-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-896-1494
-----------------------------------------------------
Fax | 609-896-3627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 FRANKLIN CORNER RD
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08648-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-896-1494
-----------------------------------------------------
Fax | 609-896-3627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | MR. THOMAS E MILLER
-----------------------------------------------------
Credential | LNHA
-----------------------------------------------------
Telephone | 609-896-1494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 06114
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------