Healthcare Provider Details

I. General information

NPI: 1477484038
Provider Name (Legal Business Name): MIRACLE CARE OF CHARLOTTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 SOUTHWOOD OAKS LN APT L
CHARLOTTE NC
28212-8409
US

IV. Provider business mailing address

301 S MCDOWELL ST STE 125-1510
CHARLOTTE NC
28204-2623
US

V. Phone/Fax

Practice location:
  • Phone: 704-905-0527
  • Fax:
Mailing address:
  • Phone: 704-905-0527
  • 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: LEMANUEL MILTON JENKINS II
Title or Position: OWNER/ AGENCY DIRECTOR
Credential:
Phone: 704-905-0527