Provider Demographics
NPI:1447963178
Name:MILLENNIAL CAPITAL INVESTMENT LLC
Entity type:Organization
Organization Name:MILLENNIAL CAPITAL INVESTMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LA SHONINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDY-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:609-705-0651
Mailing Address - Street 1:40 ABINGTON CT
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-1942
Mailing Address - Country:US
Mailing Address - Phone:609-705-0651
Mailing Address - Fax:
Practice Address - Street 1:200 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-1331
Practice Address - Country:US
Practice Address - Phone:609-705-0651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health