Provider Demographics
NPI:1003052374
Name:MILLENNIUM HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:MILLENNIUM HEALTH CARE SERVICES
Other - Org Name:MILLENNIUM PCA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DWAINE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MBA
Authorized Official - Phone:225-923-3117
Mailing Address - Street 1:PO BOX 45301
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70895
Mailing Address - Country:US
Mailing Address - Phone:225-923-3117
Mailing Address - Fax:225-923-3118
Practice Address - Street 1:1920 FLORIDA BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4970
Practice Address - Country:US
Practice Address - Phone:225-667-7626
Practice Address - Fax:225-667-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 151423747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty