MEDICARE: DESTINEDMIRACLE HCS 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

General Provider Information

NPI Number	:	1609721596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINEDMIRACLE HCS SERVICES LLC

Provider Business Mailing Address
First Line	:	8042 BOIS D ARC LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-9761
Country	:	US
Telephone Number	:	832-407-8772
Fax Number	:

Provider Business Practice Location Address
First Line	:	8042 BOIS D ARC LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-9761
Country	:	US
Telephone Number	:	832-407-8772
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EYATABE IDA AYUK
Credential	:
Telephone Number	:	832-407-8772

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/06/2026

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