Provider Demographics
NPI:1164998282
Name:MILENIA ODS LLC
Entity Type:Organization
Organization Name:MILENIA ODS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-537-4913
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-0453
Mailing Address - Country:US
Mailing Address - Phone:516-537-4913
Mailing Address - Fax:
Practice Address - Street 1:2 SIENNA WAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2148
Practice Address - Country:US
Practice Address - Phone:516-537-4913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty