Provider Demographics
NPI:1033971379
Name:MILLENNIUM LIVING INC.
Entity Type:Organization
Organization Name:MILLENNIUM LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PREWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-770-0310
Mailing Address - Street 1:6031 SILVERBROOK W
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1014
Mailing Address - Country:US
Mailing Address - Phone:248-770-0310
Mailing Address - Fax:
Practice Address - Street 1:6031 SILVERBROOK W
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1014
Practice Address - Country:US
Practice Address - Phone:248-770-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental IllnessGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty