Provider Demographics
NPI:1033349253
Name:MILLENNIUM REHAB & CONSULTING, INC.
Entity Type:Organization
Organization Name:MILLENNIUM REHAB & CONSULTING, INC.
Other - Org Name:MILLENNIUM THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:F
Authorized Official - Last Name:HENTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-331-3190
Mailing Address - Street 1:4725 MERLE HAY RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1983
Mailing Address - Country:US
Mailing Address - Phone:515-331-3190
Mailing Address - Fax:515-331-3191
Practice Address - Street 1:5260 NORTHWEST BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-2463
Practice Address - Country:US
Practice Address - Phone:563-445-2400
Practice Address - Fax:563-445-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665802Medicaid
IA0665802Medicaid