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General NPI Number Information
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NPI Number | 1871651927
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Entity Type | Organization
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Legal Business Name | MILLIES VILLAGE
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 10115 HEATHCLIFF ST
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City | SPRING HILL
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State | FL
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Zip | 34608-5850
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Country | US
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Telephone | 352-584-3672
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Fax | 352-686-3107
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Provider Business Mailing Address
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Address Line | PO BOX 9227
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City | MASARYKTOWN
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State | FL
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Zip | 34604-0104
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Country | US
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Telephone | 352-584-3672
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Fax | 352-686-3107
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANNA ELIZABETH GOLLETZ
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Credential |
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Telephone | 352-584-3672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 251COOOOOX
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License Number State | FL
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