Provider Demographics
NPI:1760568505
Name:MILLER & SON PERSONAL CARE HOME, INC.
Entity Type:Organization
Organization Name:MILLER & SON PERSONAL CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ ADMINISTATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-932-1008
Mailing Address - Street 1:136 SALEM CHURCH MILLER RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-3540
Mailing Address - Country:US
Mailing Address - Phone:478-932-1008
Mailing Address - Fax:478-932-5676
Practice Address - Street 1:136 SALEM CHURCH MILLER RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-3540
Practice Address - Country:US
Practice Address - Phone:478-932-1008
Practice Address - Fax:478-932-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility