Provider Demographics
NPI:1922091834
Name:MILLER MEMORIAL COMMUNITY, INC.
Entity Type:Organization
Organization Name:MILLER MEMORIAL COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CCO
Authorized Official - Phone:203-237-8815
Mailing Address - Street 1:360 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-5843
Mailing Address - Country:US
Mailing Address - Phone:203-237-8815
Mailing Address - Fax:203-237-5944
Practice Address - Street 1:360 BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5843
Practice Address - Country:US
Practice Address - Phone:203-237-8815
Practice Address - Fax:203-237-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2242313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075295Medicare ID - Type Unspecified