Healthcare Provider Details

I. General information

NPI: 1922265586
Provider Name (Legal Business Name): LORETTA'S LITTLE MIRACLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 N 1ST ST STE 181
FRESNO CA
93726-0517
US

IV. Provider business mailing address

4747 N 1ST ST STE 181
FRESNO CA
93726-0517
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-1225
  • Fax:
Mailing address:
  • Phone: 559-226-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: BRYON BAKER
Title or Position: PRESIDENT
Credential:
Phone: 559-226-1225