Provider Demographics
NPI:1215142591
Name:MILLERCOZYHOME
Entity type:Organization
Organization Name:MILLERCOZYHOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-256-7291
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-0459
Mailing Address - Country:US
Mailing Address - Phone:918-256-3796
Mailing Address - Fax:918-256-3692
Practice Address - Street 1:203 N GUNTER ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-2903
Practice Address - Country:US
Practice Address - Phone:918-256-3796
Practice Address - Fax:918-256-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRC1803-1803310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility