Provider Demographics
NPI:1407957558
Name:MILLER SERVICES LLC
Entity Type:Organization
Organization Name:MILLER SERVICES LLC
Other - Org Name:KRISTIE'S FAMILY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:804-868-6215
Mailing Address - Street 1:3114 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-2506
Mailing Address - Country:US
Mailing Address - Phone:804-868-6215
Mailing Address - Fax:
Practice Address - Street 1:3114 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2506
Practice Address - Country:US
Practice Address - Phone:804-329-8646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA852320900000X
VA852-01-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010291747Medicaid