MEDICARE: MILESTONES, 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	251B00000X	Case Management Agency	SW1965	ID

General Provider Information

NPI Number	:	1598967416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILESTONES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 15237
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83715-5237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2863 S TAGISH WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-9191
Country	:	US
Telephone Number	:	208-898-0197
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANA PETRIE
Credential	:
Telephone Number	:	208-861-1210

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	08/22/2020

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Directions to “MILESTONES, LLC ” Practice Location

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