Healthcare Provider Details

I. General information

NPI: 1699166108
Provider Name (Legal Business Name): MILLENIUM CLINIC OF DADE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 165TH STREET RD STE 100
MIAMI FL
33169-6306
US

IV. Provider business mailing address

1152 N UNIVERSITY DR
PEMBROKE PINES FL
33024-5000
US

V. Phone/Fax

Practice location:
  • Phone: 786-657-2272
  • Fax: 954-639-7433
Mailing address:
  • Phone: 954-559-7217
  • Fax: 954-693-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA S BATCHELDER
Title or Position: AO/CEO
Credential:
Phone: 786-487-0433