Provider Demographics
NPI:1578188967
Name:MILLER PLACE RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:MILLER PLACE RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEAUTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-394-6933
Mailing Address - Street 1:16 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4006
Mailing Address - Country:US
Mailing Address - Phone:404-394-6933
Mailing Address - Fax:864-752-1084
Practice Address - Street 1:140 COX ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-4807
Practice Address - Country:US
Practice Address - Phone:864-573-7008
Practice Address - Fax:864-752-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care