Healthcare Provider Details

I. General information

NPI: 1982208336
Provider Name (Legal Business Name): MIRACLE ADULT DAY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 N MOUNT VERNON AVE
SAN BERNARDINO CA
92411-1436
US

IV. Provider business mailing address

2050 N MOUNT VERNON AVE
SAN BERNARDINO CA
92411-1436
US

V. Phone/Fax

Practice location:
  • Phone: 909-880-0009
  • Fax: 909-880-0006
Mailing address:
  • Phone: 909-880-0009
  • Fax: 909-880-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRIDA ZAKARYAN
Title or Position: CEO
Credential:
Phone: 323-899-5510