Healthcare Provider Details

I. General information

NPI: 1003533944
Provider Name (Legal Business Name): MIRACLES IN ACTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9241 RESEDA BLVD STE 200
NORTHRIDGE CA
91324-3138
US

IV. Provider business mailing address

9241 RESEDA BLVD STE 200
NORTHRIDGE CA
91324-3138
US

V. Phone/Fax

Practice location:
  • Phone: 818-429-9103
  • Fax: 747-237-7860
Mailing address:
  • Phone: 818-429-9103
  • Fax: 747-237-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMNA BUTLER
Title or Position: DIRECTOR/OPERATOR
Credential:
Phone: 818-429-9103