Provider Demographics
NPI:1265959431
Name:MILES, CARLESSIA
Entity type:Individual
Prefix:
First Name:CARLESSIA
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 ALBANY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-3792
Mailing Address - Country:US
Mailing Address - Phone:832-746-3398
Mailing Address - Fax:
Practice Address - Street 1:4821 ALBANY RIDGE LN
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-3792
Practice Address - Country:US
Practice Address - Phone:832-746-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility