Provider Demographics
NPI:1043684376
Name:MILLBROOKE INC
Entity Type:Organization
Organization Name:MILLBROOKE INC
Other - Org Name:BRIGHTSTAR CARE SPRINGFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:217-318-3396
Mailing Address - Street 1:426 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1820
Mailing Address - Country:US
Mailing Address - Phone:217-318-3396
Mailing Address - Fax:217-717-2619
Practice Address - Street 1:426 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1820
Practice Address - Country:US
Practice Address - Phone:217-318-3396
Practice Address - Fax:217-717-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2015-N1386251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care