=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932172707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLENNIUM HOME HEALTH CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2006
-----------------------------------------------------
Last Update Date | 02/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2403 FREDERICKSBURG RD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78201-3709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-737-1545
-----------------------------------------------------
Fax | 210-736-5296
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2403 FREDERICKSBURG RD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78201-3709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-737-1545
-----------------------------------------------------
Fax | 210-736-5296
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ADMINISTRATOR
-----------------------------------------------------
Name | INEZ C GABRIEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-737-1545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 005269
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------