Provider Demographics
NPI:1457350928
Name:MILLENNIUM HEALTHCARE CENTERS II, LLC
Entity Type:Organization
Organization Name:MILLENNIUM HEALTHCARE CENTERS II, LLC
Other - Org Name:CARE ONE AT VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP & GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:A.
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-242-4000
Mailing Address - Street 1:300 OLD HOOK ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-664-8888
Mailing Address - Fax:201-263-0545
Practice Address - Street 1:300 OLD HOOK ROAD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-664-8888
Practice Address - Fax:201-263-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2070Medicaid
NJ2070Medicaid