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General NPI Number Information
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NPI Number | 1487174421
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Entity Type | Organization
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Legal Business Name | MILLENNIUM HOUSE 2, LLC
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 06/21/2017
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Provider Practice Location Address
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Address Line | 8951 BONITA BEACH RD SE STE 297
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4204
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Country | US
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Telephone | 239-992-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 19460 LA SERENA DR
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City | ESTERO
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State | FL
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Zip | 33967-0527
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Country | US
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Telephone | 239-878-4510
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN MORANO
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Credential |
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Telephone | 239-878-4510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 8985
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License Number State | FL
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