Provider Demographics
NPI:1952600611
Name:MILLENNIUM CAREGIVERS AT HOME LLC
Entity Type:Organization
Organization Name:MILLENNIUM CAREGIVERS AT HOME LLC
Other - Org Name:HEARTS THAT CARE CAREGIVERS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MBRM
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:ARNETRA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CNA, PCT
Authorized Official - Phone:813-223-2273
Mailing Address - Street 1:2221 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-6416
Mailing Address - Country:US
Mailing Address - Phone:813-223-2273
Mailing Address - Fax:888-604-3094
Practice Address - Street 1:2221 GORDON ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-6416
Practice Address - Country:US
Practice Address - Phone:813-223-2273
Practice Address - Fax:888-604-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232075253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003063200Medicaid