Healthcare Provider Details

I. General information

NPI: 1609972561
Provider Name (Legal Business Name): MILLENNIUM TREATMENT SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23700 VAN DYKE AVE
WARREN MI
48089-1669
US

IV. Provider business mailing address

22601 DETOUR ST
SAINT CLAIR SHORES MI
48082-2429
US

V. Phone/Fax

Practice location:
  • Phone: 586-758-6670
  • Fax:
Mailing address:
  • Phone: 586-202-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6802068391
License Number StateMI

VIII. Authorized Official

Name: MS. ELENOR SCHWARTZ
Title or Position: SITE DIRECTOR
Credential: LMSW
Phone: 586-758-6670