1083952014 NPI number — MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083952014 NPI number — MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLENNIUM INSTITUTE FOR ADVANCE NURSING CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083952014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE COSME, REPARTO SAN LUCAS
Provider Second Line Business Mailing Address:
ENTRADA SECTOR CANEJAS
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-708-0325
Provider Business Mailing Address Fax Number:
787-720-6072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUITE 112, MSC 404
Provider Second Line Business Practice Location Address:
100 GRAND BOULEVARD PASEOS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-5955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-708-0325
Provider Business Practice Location Address Fax Number:
787-720-6072
Provider Enumeration Date:
01/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-708-0138

Provider Taxonomy Codes

  • Taxonomy code: 315D00000X , with the licence number:  LIC44 CNC NUM 12-101 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LIC 44 . This is a "MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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