MEDICARE: MIRACLE ANGEL UNLIMITED LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	385HR2065X	Child Physical Disabilities Respite Care
4	385H00000X	Respite Care

General Provider Information

NPI Number	:	1699437814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE ANGEL UNLIMITED LLC

Provider Business Mailing Address
First Line	:	5230 GOLD TREE CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-1772
Country	:	US
Telephone Number	:	407-580-5933
Fax Number	:	321-445-5468

Provider Business Practice Location Address
First Line	:	5230 GOLD TREE CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-1772
Country	:	US
Telephone Number	:	407-580-5933
Fax Number	:	321-445-5468

Authorized Official
Title or Position	:	CEO
Name	:	MS. LAKESHA RICHARDS
Credential	:
Telephone Number	:	407-580-5933

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	10/12/2021

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