Organization
TRACEY NICOLE MILLER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACEY NICOLE MILLER NONE (ADMINISTRATOR)
(623) 535-5565
Entity
Organization
Contact information
Practice address
12641 W MERRELL ST, AVONDALE, AZ 85323-6629
(623) 535-5565
Mailing address
12641 W MERRELL ST, AVONDALE, AZ 85323-6629
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
BH2685
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139650
—
AZ
01
—
BH2685
STATE LICENSE
AZ
Enumeration date
01/25/2007
Last updated
08/22/2020
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