Healthcare Provider Details

I. General information

NPI: 1790784304
Provider Name (Legal Business Name): MILLENNIUM HEALTHCARE CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W. 90 RIDGEWOOD AVENUE
PARAMUS NJ
07652
US

IV. Provider business mailing address

W. 90 RIDGEWOOD AVENUE
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-652-1950
  • Fax: 201-652-0071
Mailing address:
  • Phone: 201-652-1950
  • Fax: 201-652-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060214
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. A. ALBERTO LUGO
Title or Position: EXECUTIVE VP & GENERAL COUNSEL
Credential:
Phone: 201-242-4000