MEDICARE: SMALL MIRACLES HOME CARE

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1518342534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMALL MIRACLES HOME CARE

Provider Business Mailing Address
First Line	:	2538 HAVERKNOLL DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1002
Country	:	US
Telephone Number	:	513-641-8966
Fax Number	:

Provider Business Practice Location Address
First Line	:	2538 HAVERKNOLL DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1002
Country	:	US
Telephone Number	:	513-641-8966
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. WANDA LYNN MASTON
Credential	:
Telephone Number	:	513-641-8966

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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