Healthcare Provider Details

I. General information

NPI: 1669166823
Provider Name (Legal Business Name): MIRACLES HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2748 HELLERMAN ST SIDE B
PHILADELPHIA PA
19149-2939
US

IV. Provider business mailing address

2748 HELLERMAN ST SIDE B
PHILADELPHIA PA
19149-2939
US

V. Phone/Fax

Practice location:
  • Phone: 267-961-5801
  • Fax: 888-883-2366
Mailing address:
  • Phone: 267-961-5801
  • Fax: 888-883-2366

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SOKOL SERJANI
Title or Position: PRESIDENT/CEO
Credential: CRNP, FNP-C
Phone: 267-961-5801