=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972911964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFF D MILLER INVESTMENTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2014
-----------------------------------------------------
Last Update Date | 03/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 S MAIN ST
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75654-3559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-722-9002
-----------------------------------------------------
Fax | 903-722-9004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 S MAIN ST
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75654-3559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-722-9002
-----------------------------------------------------
Fax | 903-722-9004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | WESLEY J HOLLOWAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-658-0619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 016464
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------