MEDICARE: MILLENNIUM HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1518350875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM HOME CARE LLC

Provider Business Mailing Address
First Line	:	395 WESTERN AVE
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-1005
Country	:	US
Telephone Number	:	617-686-3668
Fax Number	:

Provider Business Practice Location Address
First Line	:	564 MAIN ST STE 203
Second Line	:
City	:	WALTHAM
State	:	MA
Zip	:	02452-5559
Country	:	US
Telephone Number	:	617-782-0262
Fax Number	:	617-254-0464

Authorized Official
Title or Position	:	FOUNDER
Name	:	RUZAN GASPARYAN
Credential	:
Telephone Number	:	617-782-0262

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	04/29/2019

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