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General NPI Number Information
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NPI Number | 1801037247
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Entity Type | Organization
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Legal Business Name | MILTON'S MANOR
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 1607 MARTIN LUTHER KING JR DR
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City | GREENSBORO
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State | NC
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Zip | 27406-2423
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Country | US
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Telephone | 336-279-1192
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Fax | 336-279-1192
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Provider Business Mailing Address
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Address Line | 1607 MARTIN LUTHER KING JR DR
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City | GREENSBORO
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State | NC
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Zip | 27406-2423
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Country | US
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Telephone | 336-279-1192
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Fax | 336-279-1192
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Authorized Official
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Title or Position | OWNER
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Name | MS. HERMENIA MILTON
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Credential |
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Telephone | 336-279-1192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | MHL041835
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License Number State | NC
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