Provider Demographics
NPI:1235549668
Name:BRANDI MILLER
Entity Type:Organization
Organization Name:BRANDI MILLER
Other - Org Name:BRANDI MILLER
Other - Org Type:Other Name
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:AAS
Authorized Official - Phone:574-275-3099
Mailing Address - Street 1:8338 E MCCLINTIC RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567
Mailing Address - Country:US
Mailing Address - Phone:574-275-3099
Mailing Address - Fax:
Practice Address - Street 1:8338 E MCCLINTIC RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-7526
Practice Address - Country:US
Practice Address - Phone:574-275-3099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001879A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility