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General NPI Number Information
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NPI Number | 1700912771
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Entity Type | Organization
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Legal Business Name | MILLENIUM IV, INC.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1107 CARTHAGE ST
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City | SANFORD
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State | NC
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Zip | 27330-4162
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Country | US
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Telephone | 919-774-8989
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Fax | 919-776-1994
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Provider Business Mailing Address
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Address Line | 1107 CARTHAGE ST
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City | SANFORD
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State | NC
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Zip | 27330-4162
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Country | US
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Telephone | 919-774-8989
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Fax | 919-776-1994
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. LARRY STEVEN GIBSON
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Credential |
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Telephone | 919-774-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | HAL053010
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License Number State | NC
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