Provider Demographics
NPI:1083952014
Name:MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE INC
Entity Type:Organization
Organization Name:MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-708-0138
Mailing Address - Street 1:CALLE COSME, REPARTO SAN LUCAS
Mailing Address - Street 2:ENTRADA SECTOR CANEJAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-708-0325
Mailing Address - Fax:787-720-6072
Practice Address - Street 1:SUITE 112, MSC 404
Practice Address - Street 2:100 GRAND BOULEVARD PASEOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5955
Practice Address - Country:US
Practice Address - Phone:787-708-0325
Practice Address - Fax:787-720-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRLIC44 CNC NUM 12-101315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRLIC 44OtherMEDICARE