Provider Demographics
NPI:1720381999
Name:RILEY MILLERS CONSTRUCTION LLC.
Entity Type:Organization
Organization Name:RILEY MILLERS CONSTRUCTION LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-304-1408
Mailing Address - Street 1:3725 PAWNEE DR SE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-8971
Mailing Address - Country:US
Mailing Address - Phone:320-304-1408
Mailing Address - Fax:320-762-9148
Practice Address - Street 1:3725 PAWNEE DR SE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-8971
Practice Address - Country:US
Practice Address - Phone:320-304-1408
Practice Address - Fax:320-762-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20638952305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service