Healthcare Provider Details

I. General information

NPI: 1497812812
Provider Name (Legal Business Name): MIRACLES OF LIFE DAY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5914 W NORTH AVE
CHICAGO IL
60639-4013
US

IV. Provider business mailing address

5914 W NORTH AVE
CHICAGO IL
60639-4013
US

V. Phone/Fax

Practice location:
  • Phone: 773-237-0484
  • Fax: 773-626-1077
Mailing address:
  • Phone: 773-237-0484
  • Fax: 773-626-1077

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: MR. RICKIE PIERRE BROWN SR.
Title or Position: CEO
Credential:
Phone: 773-237-0484