MEDICARE: MILLER HOMECARE LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1538980032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLER HOMECARE LLC

Provider Business Mailing Address
First Line	:	74 PARK RD UNIT 74-2
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	74 PARK RD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1853
Country	:	US
Telephone Number	:	347-906-4528
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANEKA MILLER
Credential	:	RN
Telephone Number	:	347-906-4528

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	10/18/2024

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