Organization
MILLERNAIRCLUB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAKARA DOMINIQUE RICKS (CEO)
(252) 370-5964
Entity
Organization
Contact information
Practice address
100 CARRIAGE HOUSE DR, SUFFOLK, VA 23434-9219
(252) 370-5964
Mailing address
100 CARRIAGE HOUSE DR, SUFFOLK, VA 23434-9219
(252) 370-5964
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/27/2021
Last updated
09/27/2021
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