MEDICARE: MILLENNIUM CAREGIVERS AT HOME 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	253Z00000X	In Home Supportive Care Agency	232075	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952600611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM CAREGIVERS AT HOME LLC

Provider Business Mailing Address
First Line	:	2221 GORDON ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-6416
Country	:	US
Telephone Number	:	813-223-2273
Fax Number	:	888-604-3094

Provider Business Practice Location Address
First Line	:	2221 GORDON ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-6416
Country	:	US
Telephone Number	:	813-223-2273
Fax Number	:	888-604-3094

Authorized Official
Title or Position	:	MBRM
Name	:	MRS. CONNIE ARNETRA HARRIS
Credential	:	C.N.A., P.C.T.
Telephone Number	:	813-223-2273

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/21/2011

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