Provider Demographics
NPI:1417490848
Name:A MILE OF COMFORT LLC
Entity Type:Organization
Organization Name:A MILE OF COMFORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-221-9756
Mailing Address - Street 1:771 E SOUTHLAKE BLVD
Mailing Address - Street 2:209
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6341
Mailing Address - Country:US
Mailing Address - Phone:817-761-5006
Mailing Address - Fax:
Practice Address - Street 1:771 E SOUTHLAKE BLVD
Practice Address - Street 2:209
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6341
Practice Address - Country:US
Practice Address - Phone:817-761-5006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-03
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX017576251E00000X, 251G00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367707201Medicaid