Provider Demographics
NPI:1679917546
Name:JEFF D MILLER LLC
Entity Type:Organization
Organization Name:JEFF D MILLER LLC
Other - Org Name:ROCK HAVEN NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-571-3872
Mailing Address - Street 1:10509 COUNTY ROAD 456 S
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-6257
Mailing Address - Country:US
Mailing Address - Phone:903-571-3872
Mailing Address - Fax:903-854-4703
Practice Address - Street 1:401 SE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-7204
Practice Address - Country:US
Practice Address - Phone:936-569-9411
Practice Address - Fax:936-569-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004953314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004953Medicaid
TX676340Medicare Oscar/Certification