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General NPI Number Information
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NPI Number | 1417498130
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Entity Type | Organization
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Legal Business Name | MILLENNIUM RECOVERY CENTER
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 115 SW 11TH AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-1527
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Country | US
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Telephone | 754-444-8411
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Fax |
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Provider Business Mailing Address
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Address Line | 115 SW 11TH AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-1527
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | ANGELA IACULLO
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Credential |
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Telephone | 561-513-6545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | FL
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