Provider Demographics
NPI:1902666845
Name:MILLENNIUM RESIDENTIAL INC.
Entity Type:Organization
Organization Name:MILLENNIUM RESIDENTIAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TENICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-409-3677
Mailing Address - Street 1:848 KATHY DIANNE DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-6898
Mailing Address - Country:US
Mailing Address - Phone:443-531-1988
Mailing Address - Fax:
Practice Address - Street 1:744 DULANEY VALLEY RD STE 15
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5132
Practice Address - Country:US
Practice Address - Phone:443-409-3677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty