Healthcare Provider Details

I. General information

NPI: 1255245528
Provider Name (Legal Business Name): MILLENNIUM VENTURES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MEDICAL CENTER DR STE 350
LARGO MD
20774-3715
US

IV. Provider business mailing address

9500 MEDICAL CENTER DR STE 350
LARGO MD
20774-3715
US

V. Phone/Fax

Practice location:
  • Phone: 240-247-2201
  • Fax: 240-525-0892
Mailing address:
  • Phone: 240-247-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: BERNADINE NKIRU EBURUOH
Title or Position: DIRECTOR
Credential: PMHNP
Phone: 301-655-7455