Provider Demographics
NPI:1518182336
Name:MILLENNIUM HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:MILLENNIUM HEALTH CARE SERVICES
Other - Org Name:MILLENNIUM PCA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DWAINE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-923-3117
Mailing Address - Street 1:PO BOX 45301
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70895-4301
Mailing Address - Country:US
Mailing Address - Phone:225-923-3117
Mailing Address - Fax:225-923-3118
Practice Address - Street 1:921 N LOBDELL AVE
Practice Address - Street 2:SUITE G-1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8811
Practice Address - Country:US
Practice Address - Phone:225-923-3117
Practice Address - Fax:225-923-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 113993747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1471593Medicaid
LA1475947Medicaid