Healthcare Provider Details

I. General information

NPI: 1649703943
Provider Name (Legal Business Name): MIRACLEONE UNIVERSAL HEALTH CARE AND STAFFYING AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4372 MORNINGWOOD DR
OLNEY MD
20832-2829
US

IV. Provider business mailing address

4372 MORNINGWOOD DR
OLNEY MD
20832-2829
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-1560
  • Fax: 301-774-9620
Mailing address:
  • Phone: 301-774-1560
  • Fax: 301-774-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberRN965982
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN965982
License Number StateDC

VIII. Authorized Official

Name: MRS. OLGA MAUD SIMON
Title or Position: CEO/PRESIDENT
Credential: RN, MSN, BSN
Phone: 301-774-1560