MEDICARE: MIRACLE HANDS PERSONAL HOME CARE 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	253Z00000X	In Home Supportive Care Agency		NV

General Provider Information

NPI Number	:	1861888091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE HANDS PERSONAL HOME CARE LLC

Provider Business Mailing Address
First Line	:	10717 ELFSTROM AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10717 ELFSTROM AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6019
Country	:	US
Telephone Number	:	702-524-8166
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROSMERY GARCIA
Credential	:
Telephone Number	:	702-524-8166

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	04/14/2015

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