Healthcare Provider Details

I. General information

NPI: 1780752071
Provider Name (Legal Business Name): MIRACLE CAREGIVERS FOR NEEDY CHILDREN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 WILLIS MILL RD SW
ATLANTA GA
30311-1730
US

IV. Provider business mailing address

366 WILLIS MILL RD SW
ATLANTA GA
30311-1730
US

V. Phone/Fax

Practice location:
  • Phone: 404-696-4220
  • Fax: 404-699-2676
Mailing address:
  • Phone: 404-696-4220
  • Fax: 404-699-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberFR-17061
License Number StateGA

VIII. Authorized Official

Name: MRS. CLORISSAL RENEL ALCANTARA
Title or Position: CEO
Credential: N.A
Phone: 404-696-4220