Healthcare Provider Details

I. General information

NPI: 1912010109
Provider Name (Legal Business Name): MILLENNIUM MANAGEMENT & CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 N CLARK AVE
SAINT LOUIS MO
63135-2323
US

IV. Provider business mailing address

37 N CLARK AVE
SAINT LOUIS MO
63135-2323
US

V. Phone/Fax

Practice location:
  • Phone: 314-521-7419
  • Fax: 314-521-6889
Mailing address:
  • Phone: 314-521-7419
  • Fax: 314-521-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberO31149
License Number StateMO

VIII. Authorized Official

Name: JOHN BRENCICK
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-374-7419