MEDICARE: MIRACLES OF LIFE DAY SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1497812812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLES OF LIFE DAY SERVICES INC.

Provider Business Mailing Address
First Line	:	5914 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4013
Country	:	US
Telephone Number	:	773-237-0484
Fax Number	:	773-626-1077

Provider Business Practice Location Address
First Line	:	5914 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4013
Country	:	US
Telephone Number	:	773-237-0484
Fax Number	:	773-626-1077

Authorized Official
Title or Position	:	CEO
Name	:	MR. RICKIE PIERRE BROWN SR.
Credential	:
Telephone Number	:	773-237-0484

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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