MEDICARE: MILLENNIUM ADULT FOSTER 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	:	1922729144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM ADULT FOSTER CARE, LLC

Provider Business Mailing Address
First Line	:	564 MAIN ST STE 203
Second Line	:
City	:	WALTHAM
State	:	MA
Zip	:	02452-5559
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	:	617-686-3668
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RUZAN GASPARYAN
Credential	:
Telephone Number	:	617-686-3668

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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