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Organization
MILLENNIUM MANOR CDS LLC
Active
Organization
MILLENNIUM MANOR CDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA LATEIKE WILLIAMS (CEO)
(314) 933-0415
Entity
Organization
Contact information
Practice address
147 BERRY MANOR CIR, SAINT PETERS, MO 63376-5392
(314) 933-0415
Mailing address
147 BERRY MANOR CIR, SAINT PETERS, MO 63376-5392
(314) 933-0415
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
NULL
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
251E00000X
Home Health Agency
Primary
—
NULL
251K00000X
Public Health or Welfare Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
251V00000X
Voluntary or Charitable Agency
—
NULL
252Y00000X
Early Intervention Provider Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
261Q00000X
Clinic/Center
—
NULL
261QA0600X
Adult Day Care Clinic/Center
—
NULL
261QC1500X
Community Health Clinic/Center
—
NULL
261QF0400X
Federally Qualified Health Center (FQHC)
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
305R00000X
Preferred Provider Organization
—
NULL
305S00000X
Point of Service
—
NULL
Other
Enumeration date
10/03/2025
Last updated
10/03/2025
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