Healthcare Provider Details

I. General information

NPI: 1457603623
Provider Name (Legal Business Name): MIRACLE HANDS CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 SAINT MICHAELS DR
BOWIE MD
20721-1961
US

IV. Provider business mailing address

807 SAINT MICHAELS DR
BOWIE MD
20721-1961
US

V. Phone/Fax

Practice location:
  • Phone: 301-275-1805
  • Fax: 301-430-7380
Mailing address:
  • Phone: 301-275-1805
  • Fax: 301-430-7380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR3317
License Number StateMD

VIII. Authorized Official

Name: MRS. RIANET ABOUDU EDIONSERI
Title or Position: CEO
Credential: LPN-NURSE
Phone: 301-275-1805