MEDICARE: MIRACLE HOME CARE SERVICES LLC

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	HC3431	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558414607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1914 J N PEASE PL
Second Line	:	104
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4504
Country	:	US
Telephone Number	:	704-858-0081
Fax Number	:	704-919-3470

Provider Business Practice Location Address
First Line	:	1914 J N PEASE PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4504
Country	:	US
Telephone Number	:	704-858-0081
Fax Number	:	704-919-3470

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	MS. PAULETTE RUTHINA MCGEE
Credential	:
Telephone Number	:	704-858-0081

Provider Enumeration Date	:	01/20/2007
Last Update Date	:	07/30/2008

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