Healthcare Provider Details

I. General information

NPI: 1427937903
Provider Name (Legal Business Name): JEFFERY'S MIRACLE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 INDUSTRAIL BLVD
INDIANAPOLIS IN
46254
US

IV. Provider business mailing address

3910 INDUSTRIAL BLVD
INDIANAPOLIS IN
46254-2510
US

V. Phone/Fax

Practice location:
  • Phone: 317-794-9168
  • Fax:
Mailing address:
  • Phone: 317-794-9168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANNON MCBRIDE
Title or Position: OWNER
Credential:
Phone: 317-794-6198