Provider Demographics
NPI:1063953818
Name:MILLENNIUM VENTURES CORPORATION
Entity type:Organization
Organization Name:MILLENNIUM VENTURES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:POLYCARP
Authorized Official - Middle Name:
Authorized Official - Last Name:EBURUOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-655-7114
Mailing Address - Street 1:9500 ARENA DRIVE
Mailing Address - Street 2:SUITE 440E
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:301-494-5722
Mailing Address - Fax:240-525-0892
Practice Address - Street 1:9500 ARENA DRIVE
Practice Address - Street 2:SUITE 440E
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:301-494-5722
Practice Address - Fax:240-525-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MDR4017253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health