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General NPI Number Information
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NPI Number | 1619148897
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Entity Type | Organization
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Legal Business Name | MILLENNIUM TREATMENT SERVICES LLC
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 23700 VAN DYKE AVE
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City | WARREN
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State | MI
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Zip | 48089-1669
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Country | US
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Telephone | 586-758-6670
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Fax | 586-758-0243
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Provider Business Mailing Address
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Address Line | 1400 E 12 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2651
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Country | US
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Telephone | 248-547-2223
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Fax | 248-547-2226
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ANTHONY COSIMO CLEMENTE
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Credential | LMSW
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Telephone | 586-758-6670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 500371
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License Number State | MI
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