Healthcare Provider Details

I. General information

NPI: 1972220341
Provider Name (Legal Business Name): EVERLASTING MIRACLES HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 MANTUA BLVD
SEWELL NJ
08080-1354
US

IV. Provider business mailing address

919 MANTUA BLVD
SEWELL NJ
08080-1354
US

V. Phone/Fax

Practice location:
  • Phone: 856-308-8805
  • Fax:
Mailing address:
  • Phone: 856-308-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ROBERT W ANDERS
Title or Position: OWNER
Credential:
Phone: 856-308-8805