Provider Demographics
NPI:1275915951
Name:MILLER GROUP HOME INC
Entity Type:Organization
Organization Name:MILLER GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-938-4376
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-0112
Mailing Address - Country:US
Mailing Address - Phone:732-938-4376
Mailing Address - Fax:732-938-9742
Practice Address - Street 1:5208 MEGILL ROAD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727
Practice Address - Country:US
Practice Address - Phone:732-938-4376
Practice Address - Fax:732-938-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH020261QD1600X
NJGH749261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities