Provider Demographics
NPI:1912010109
Name:MILLENNIUM MANAGEMENT & CONSULTING, INC.
Entity Type:Organization
Organization Name:MILLENNIUM MANAGEMENT & CONSULTING, INC.
Other - Org Name:OAK KNOLL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENCICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-374-7419
Mailing Address - Street 1:37 N CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2323
Mailing Address - Country:US
Mailing Address - Phone:314-521-7419
Mailing Address - Fax:314-521-6889
Practice Address - Street 1:37 N CLARK AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63135-2323
Practice Address - Country:US
Practice Address - Phone:314-521-7419
Practice Address - Fax:314-521-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOO31149314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108713900Medicaid
MO108713900Medicaid