Tracey Nicole Miller

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

BH2685 Issued in AZ

Legal business name

TRACEY NICOLE MILLER

Practice address

12641 W Merrell St
Avondale, AZ 85323-6629

Phone

(623) 535-5565

NPI assigned

Jan 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tracey Nicole Miller, NONE

Title

Administrator

Phone

(623) 535-5565

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457406589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12641 W MERRELL ST",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853236629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12641 W MERRELL ST",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853236629",
            "telephone_number": "623-535-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACEY NICOLE MILLER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "623-535-5565",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NONE"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "AZ",
            "license": "BH2685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "BH2685",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139650",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Assisted Living Facility (Mental Illness) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.