Provider Demographics
NPI:1326690074
Name:MILLENNIUM HOME ADULT DAY HEALTHCARE
Entity Type:Organization
Organization Name:MILLENNIUM HOME ADULT DAY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-854-0678
Mailing Address - Street 1:5 LYBERTY WAY
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3617
Mailing Address - Country:US
Mailing Address - Phone:323-854-0678
Mailing Address - Fax:
Practice Address - Street 1:5 LYBERTY WAY
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3617
Practice Address - Country:US
Practice Address - Phone:323-854-0678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care