Provider Demographics
NPI:1043640360
Name:MILLENNIUM HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:MILLENNIUM HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MULUEMBET
Authorized Official - Middle Name:
Authorized Official - Last Name:FISSEHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-862-8447
Mailing Address - Street 1:4810 BEAUREGARD ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1709
Mailing Address - Country:US
Mailing Address - Phone:703-941-8412
Mailing Address - Fax:
Practice Address - Street 1:4810 BEAUREGARD ST
Practice Address - Street 2:SUITE 325
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1709
Practice Address - Country:US
Practice Address - Phone:703-941-8412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-14982251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0171824805Medicaid
VA0171830612Medicaid
VA0171836569Medicaid