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General NPI Number Information
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NPI Number | 1770986077
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Entity Type | Organization
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Legal Business Name | MILLENNIAL PERSONAL CARE SERVICE, LLC
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 1717 SAINT JAMES PL SUITE 625
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City | HOUSTON
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State | TX
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Zip | 77056-3404
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Country | US
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Telephone | 662-491-8889
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 SAINT JAMES PL SUITE 625
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City | HOUSTON
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State | TX
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Zip | 77056-3404
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Country | US
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Telephone | 662-491-8889
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Fax |
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Authorized Official
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Title or Position | ALTERNATE ADMINISTRATOR
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Name | MS. CHERONDA LYNN RUTHERFORD
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Credential | MSW
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Telephone | 662-491-8889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 017543
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License Number State | TX
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