Provider Demographics
NPI:1437852266
Name:MILLENNIAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MILLENNIAL HEALTHCARE, LLC
Other - Org Name:MILLENNIAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:JAQUETTA NICOLE
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-882-4878
Mailing Address - Street 1:655 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5842
Mailing Address - Country:US
Mailing Address - Phone:601-882-4878
Mailing Address - Fax:
Practice Address - Street 1:5290 GALAXIE DR STE 105
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4311
Practice Address - Country:US
Practice Address - Phone:601-882-4878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)