Provider Demographics
NPI:1972909505
Name:VANCE MILLER SUPPORTIVE SERVICES LLC
Entity type:Organization
Organization Name:VANCE MILLER SUPPORTIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZOEMEEKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:419-508-5562
Mailing Address - Street 1:1139 AMANDA CIR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6764
Mailing Address - Country:US
Mailing Address - Phone:419-508-5562
Mailing Address - Fax:
Practice Address - Street 1:1139 AMANDA CIR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6764
Practice Address - Country:US
Practice Address - Phone:419-508-5562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services