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General NPI Number Information
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NPI Number | 1912010109
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Entity Type | Organization
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Legal Business Name | MILLENNIUM MANAGEMENT & CONSULTING, INC.
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 37 N CLARK AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63135-2323
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Country | US
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Telephone | 314-521-7419
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Fax | 314-521-6889
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Provider Business Mailing Address
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Address Line | 37 N CLARK AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63135-2323
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Country | US
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Telephone | 314-521-7419
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Fax | 314-521-6889
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN BRENCICK
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Credential |
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Telephone | 314-374-7419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | O31149
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License Number State | MO
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