Mill Creek Manor, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MILL CREEK MANOR, LLC

Practice address

1902 Ora Dr
Statesville, NC 28625-6343

Phone

(704) 878-0879

NPI assigned

May 2, 2019

Organization subpart

No

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

Authorized official

Name

Mr. John Miller

Title

Managing Member

Phone

(704) 878-0879

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1556755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556755200000",
    "number": "1689239923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 ORA DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286256343",
            "telephone_number": "704-878-0879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 ORA DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286256343",
            "telephone_number": "704-878-0879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL CREEK MANOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-02",
        "last_updated": "2019-05-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "704-878-0879",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael C Woods DMD PLLC
• Michael J Piazza PLLC
• Paul Matthew Michaud, MD
• Marina Mickael
• Ronald W Milam, O.D.
• Miller Family Practice PC
• Aimee Rae Miller, PTA
• Barbara Miller, LCMHCS
• David John Miller II, LCSW-A
• Michael Ray Miller, MD

• Assisted Living Facility in Statesville, NC
• Providers in Statesville, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.