Provider Demographics
NPI:1497076889
Name:MILLENNIUM HOUSE OF SOUTHWEST FLORIDA, INC
Entity Type:Organization
Organization Name:MILLENNIUM HOUSE OF SOUTHWEST FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RYERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-992-5513
Mailing Address - Street 1:8951 BONITA BEACH RD SE
Mailing Address - Street 2:SUITE 297
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4201
Mailing Address - Country:US
Mailing Address - Phone:239-992-5513
Mailing Address - Fax:239-992-2238
Practice Address - Street 1:8951 BONITA BEACH RD SE
Practice Address - Street 2:SUITE 297
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4201
Practice Address - Country:US
Practice Address - Phone:239-992-5513
Practice Address - Fax:239-992-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-19
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAD8985385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care