MEDICARE: MILLENNIUM TREATMENT SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2800X	Methadone Clinic	500371	MI
2	261QM2800X	Methadone Clinic	631090	MI

General Provider Information

NPI Number	:	1972535474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM TREATMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	1400 E 12 MILE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-2651
Country	:	US
Telephone Number	:	248-547-2223
Fax Number	:	248-547-2226

Provider Business Practice Location Address
First Line	:	1400 E 12 MILE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-2651
Country	:	US
Telephone Number	:	248-547-2223
Fax Number	:	248-547-2226

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ANTHONY COSIMO CLEMENTE
Credential	:
Telephone Number	:	248-932-3412

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/08/2007

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