MILLENNIUM RESIDENTIAL HOME INC. (NPI# 1720579022) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720579022 |
| Entity Type | Organization |
| Organization Name | MILLENNIUM RESIDENTIAL HOME INC. |
| Practice Address |
10325 W San Juan Ave Glendale AZ 85307-4310 |
| Practice Telephone | 6234182266 |
| Practice Fax Number | 6232181520 |
| Mailing Telephone | 6234182266 |
| Mailing Fax Number | 6232181520 |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2018-05-22 |
| Authorized Official Name | TIMIADI EDOGI (ADMINISTRATOR) |
| Authorized Official Telephone | 6234182266 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
Nursing & Custodial Care Facilities |
| Street Address |
10325 W SAN JUAN AVE |
| City | GLENDALE |
| State | AZ |
| Zip Code | 85307-4310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942667332 | Timiadi Edogi | Social Worker | 10325 W San Juan Ave, Glendale, AZ 85307-4310 | 2016-01-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154635761 | Aeroptics LLC | Optometrist | 7071 N 138th Av, Bldg 1540, Glendale, AZ 85307 | 2010-08-06 |
| 1902894579 | Daniela Nicosia | Optometrist | 7071 N 138th Ave, Luke Afb, AZ 85307 | 2005-10-07 |
| 1144633157 | Sharan Kaur Knott | Pharmacist | 10945 W Vista Ln, Glendale, AZ 85307-1645 | 2014-06-06 |
| 1841813961 | Yoshica Mitchell | Behavior Technician | 12923 W Lawrence Ct, Glendale, AZ 85307-1900 | 2020-05-22 |
| 1700328556 | Tonya Brown | Social Worker | 12912 W Mclellan Rd, Glendale, AZ 85307-1917 | 2016-11-10 |
| 1447806997 | Tamarra Kalamchi | Dentist | 7071 N 138th Ave Bldg 1540, Glendale, AZ 85307-2006 | 2019-08-12 |
| 1043623648 | Dr Larsen Eye Care Inc | Optometrist | 7071 N 138th Ave # 1552, Luke Afb, AZ 85307-2006 | 2014-06-11 |
| 1619519840 | Platinum Venture Group LLC | Durable Medical Equipment & Medical Supplies | 7071 N 138th Ave Bldg 1540, Glendale, AZ 85307-2006 | 2019-10-09 |
| 1710255989 | Optical Center | Technician/Technologist | 7071 N 138th Ave, Glendale, AZ 85307-2006 | 2011-12-02 |
| 1386088128 | Clifton Jamar Premo | Respiratory Therapist, Registered | 13517 W Glendale Ave, Apt 1135, Glendale, AZ 85307-2010 | 2013-04-23 |
| Find all providers in zip 85307 | ||||
| Taxonomy Code | 3104A0630X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Behavioral Disturbances |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336498906 | Revival Home Care | Assisted Living Facility | 8269 W State Ave, Glendale, AZ 85303 | 2012-08-29 |
| 1649736026 | Lakeview Assisted Living LLC | Assisted Living Facility | 20044 N 68th Dr, Glendale, AZ 85308-5594 | 2019-02-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912511999 | Fanaka Enterprises LLC | Assisted Living Facility | 3925 E 1st St, Tucson, AZ 85711-1001 | 2020-09-07 |
| 1114536752 | The Heritage Behavioral Health Home LLC | Assisted Living Facility | 3927 W Rovey Ave, Phoenix, AZ 85019-1633 | 2020-07-29 |
| 1801420476 | Holy Trinity Behavioral,llc | Assisted Living Facility | 1630 W Nancy Ln, Phoenix, AZ 85041-5540 | 2020-02-23 |
| 1184258758 | Holy Trinity Behavioral,llc | Assisted Living Facility | 5308 W Vernon Ave, Phoenix, AZ 85035-1953 | 2020-02-23 |
| 1487287108 | Christine M Kemboi | Assisted Living Facility | 8435 W Hughes Dr, Tolleson, AZ 85353-3902 | 2020-02-20 |
| 1154967826 | Home of Empathy LLC | Assisted Living Facility | 8102 E 6th St, Tucson, AZ 85710-2416 | 2019-11-18 |
| 1083261945 | D&g Behavioral Health LLC | Assisted Living Facility | 3119 N 46th Dr, Phoenix, AZ 85031-3705 | 2019-08-24 |
| 1881249902 | A Tender Hand Assisted Living Home, LLC, Dba | Assisted Living Facility | 6216 S 36th St, Phoenix, AZ 85042-4904 | 2019-08-06 |
| 1265098339 | Affinity of Hope Care Home | Assisted Living Facility | 7518 S 15th Dr, Phoenix, AZ 85041-6935 | 2019-05-14 |
| 1912561176 | Hope Behavioral Health Residential Care | Assisted Living Facility | 17547 W Desert Bloom St, Goodyear, AZ 85338-4713 | 2019-04-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.