Provider Demographics
NPI:1659806545
Name:MILESTONE GROUP HOMES & NURSING
Entity Type:Organization
Organization Name:MILESTONE GROUP HOMES & NURSING
Other - Org Name:MILESTONE GROUP HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:T
Authorized Official - Last Name:NOUWEZEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:7038-691-1220
Mailing Address - Street 1:9014 ORANGE HUNT LN
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4126
Mailing Address - Country:US
Mailing Address - Phone:703-869-1120
Mailing Address - Fax:187-725-2103
Practice Address - Street 1:9014 ORANGE HUNT LN
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-4126
Practice Address - Country:US
Practice Address - Phone:703-869-1120
Practice Address - Fax:187-725-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2573320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities