Healthcare Provider Details

I. General information

NPI: 1396123923
Provider Name (Legal Business Name): A MIRACLE HOME CARE SKILLED SERVICES CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10490 TACONIC TER STE 300
CINCINNATI OH
45215-1123
US

IV. Provider business mailing address

1715 HARMON DR
CINCINNATI OH
45215-1455
US

V. Phone/Fax

Practice location:
  • Phone: 513-936-1313
  • Fax: 513-791-0836
Mailing address:
  • Phone: 513-616-0544
  • Fax: 513-297-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RAD GALITSKY
Title or Position: PRESIDENT
Credential:
Phone: 513-616-0544