Healthcare Provider Details

I. General information

NPI: 1649052820
Provider Name (Legal Business Name): A MIRACLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31904 CALHOUN CT
WESTLAND MI
48186-4708
US

IV. Provider business mailing address

31904 CALHOUN CT
WESTLAND MI
48186-4708
US

V. Phone/Fax

Practice location:
  • Phone: 734-444-8987
  • Fax: 734-725-5466
Mailing address:
  • Phone: 734-444-8987
  • Fax: 734-725-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. PETRONIA BELL
Title or Position: PRESIDENT
Credential:
Phone: 734-444-8987