MEDICARE: LATOYA MCMILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL-019-073	NC

General Provider Information

NPI Number	:	1467025270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA MCMILLER

Provider Business Mailing Address
First Line	:	PO BOX 384
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27331-0384
Country	:	US
Telephone Number	:	910-729-9659
Fax Number	:

Provider Business Practice Location Address
First Line	:	7824 PITTSBORO GOLDSTON RD
Second Line	:
City	:	BEAR CREEK
State	:	NC
Zip	:	27207-9551
Country	:	US
Telephone Number	:	919-898-4112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	07/20/2021

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