Provider Demographics
NPI:1558159467
Name:MILESTONES OVER FAYETTEVILLE LLC
Entity type:Organization
Organization Name:MILESTONES OVER FAYETTEVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-878-7648
Mailing Address - Street 1:6977 NEXUS CT STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2651
Mailing Address - Country:US
Mailing Address - Phone:910-263-8932
Mailing Address - Fax:
Practice Address - Street 1:6977 NEXUS CT STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2651
Practice Address - Country:US
Practice Address - Phone:910-263-8932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health