Provider Demographics
NPI:1417585910
Name:MILLENNIUM MEDICAL GROUP
Entity Type:Organization
Organization Name:MILLENNIUM MEDICAL GROUP
Other - Org Name:ESPERANZA HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEISHLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEREZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-654-5565
Mailing Address - Street 1:1680 COOPER FOSTER PARK RD W STE C
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3657
Mailing Address - Country:US
Mailing Address - Phone:440-444-0030
Mailing Address - Fax:440-444-0113
Practice Address - Street 1:1680 COOPER FOSTER PARK RD W STE C
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3657
Practice Address - Country:US
Practice Address - Phone:440-444-0030
Practice Address - Fax:440-444-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health