Organization
MILLENIUM IV, INC.
Active
Other names
Victorian
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY STEVEN GIBSON (ADMINISTRATOR)
(919) 774-8989
Entity
Organization
Contact information
Practice address
1107 CARTHAGE ST, SANFORD, NC 27330-4162
(919) 774-8989
(919) 776-1994
Mailing address
1107 CARTHAGE ST, SANFORD, NC 27330-4162
(919) 774-8989
(919) 776-1994
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL053010
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804097
—
NC
Enumeration date
02/26/2007
Last updated
08/22/2020
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