Provider Demographics
NPI:1851553499
Name:MILLENNIUM THERAPY AND CONSULTING GROUP
Entity Type:Organization
Organization Name:MILLENNIUM THERAPY AND CONSULTING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, PT
Authorized Official - Phone:515-331-3190
Mailing Address - Street 1:4725 MERLE HAY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1983
Mailing Address - Country:US
Mailing Address - Phone:515-331-3190
Mailing Address - Fax:
Practice Address - Street 1:4725 MERLE HAY RD STE 107
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1983
Practice Address - Country:US
Practice Address - Phone:515-331-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004072314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility