Healthcare Provider Details

I. General information

NPI: 1326690074
Provider Name (Legal Business Name): MILLENNIUM HOME ADULT DAY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LYBERTY WAY
WESTFORD MA
01886-3617
US

IV. Provider business mailing address

5 LYBERTY WAY
WESTFORD MA
01886-3617
US

V. Phone/Fax

Practice location:
  • Phone: 323-854-0678
  • Fax:
Mailing address:
  • Phone: 323-854-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. INNA PROSHAK
Title or Position: CORPORATE OFFICER
Credential:
Phone: 323-854-0678