Provider Demographics
NPI:1336329614
Name:MILESTONES TREATMENT & LEARNING CENTER, INC
Entity Type:Organization
Organization Name:MILESTONES TREATMENT & LEARNING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SOLOMON
Authorized Official - Last Name:CUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MED/CCC
Authorized Official - Phone:336-659-0806
Mailing Address - Street 1:3640 WESTGATE CENTER CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3056
Mailing Address - Country:US
Mailing Address - Phone:336-659-0806
Mailing Address - Fax:
Practice Address - Street 1:3640 WESTGATE CENTER CIR
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3056
Practice Address - Country:US
Practice Address - Phone:336-659-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC26450OtherBCBS
NC51047116OtherTRICARE PROVIDER NUMBER
NC7426450Medicaid
NC694621OtherUNITED HEALTH CARE
NC9340223OtherAETNA
NCB1272OtherMEDCOST PRACTICE ID
NC7211967Medicaid
NCE2524OtherMEDCOST DR ID