Healthcare Provider Details

I. General information

NPI: 1639003098
Provider Name (Legal Business Name): MIRACLES OF A SECOND CHANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 19TH TER
BISBEE AZ
85603-1705
US

IV. Provider business mailing address

PO BOX 1002
BISBEE AZ
85603-2002
US

V. Phone/Fax

Practice location:
  • Phone: 520-266-8906
  • Fax:
Mailing address:
  • Phone: 520-266-8906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: ALMA I HICKMAN
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 520-266-8906