Healthcare Provider Details

I. General information

NPI: 1003854662
Provider Name (Legal Business Name): MILLENNIUM HEALTH AND REHABILITATION CENTER OF FORESTVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 MARLBORO PIKE
FORESTVILLE MD
20747-4343
US

IV. Provider business mailing address

930 RIDGEBROOK RD
SPARKS MD
21152-9390
US

V. Phone/Fax

Practice location:
  • Phone: 301-736-0240
  • Fax:
Mailing address:
  • Phone: 410-773-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number16-017
License Number StateMD

VIII. Authorized Official

Name: MATTHEW BOX
Title or Position: EVP
Credential:
Phone: 410-773-1000