Healthcare Provider Details

I. General information

NPI: 1437636966
Provider Name (Legal Business Name): MIRACLE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 HICKORY RD STE 306
HOMEWOOD IL
60430
US

IV. Provider business mailing address

20901 CORINTH RD
OLYMPIA FIELDS IL
60461-1872
US

V. Phone/Fax

Practice location:
  • Phone: 773-573-9843
  • Fax:
Mailing address:
  • Phone: 773-573-9843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4000553
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4000553
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number4000553
License Number StateIL

VIII. Authorized Official

Name: DALE MUHAMMAD
Title or Position: OWNER
Credential: RN
Phone: 708-769-0196