# MILLENNIUM MANOR CDS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972477644
- **Authorized official:** CARLA LATEIKE WILLIAMS (CEO)
- **Authorized official phone:** (314) 933-0415

## Contact information

- **Practice address:** 147 BERRY MANOR CIR, SAINT PETERS, MO 63376-5392
- **Practice address phone:** (314) 933-0415
- **Mailing address:** 147 BERRY MANOR CIR, SAINT PETERS, MO 63376-5392
- **Mailing address phone:** (314) 933-0415

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 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