Provider Demographics
NPI:1700058583
Name:MILLENNIUM HOME CARE LLC
Entity Type:Organization
Organization Name:MILLENNIUM HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:REIS-COELHO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:855-674-7501
Mailing Address - Street 1:1500 KINGS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980
Mailing Address - Country:US
Mailing Address - Phone:855-674-7500
Mailing Address - Fax:855-674-7501
Practice Address - Street 1:1500 KINGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980
Practice Address - Country:US
Practice Address - Phone:855-674-7500
Practice Address - Fax:855-674-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993118251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health