Healthcare Provider Details

I. General information

NPI: 1700214822
Provider Name (Legal Business Name): MIRACLE HANDS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 S BUNCOMBE RD APT 501
GREER SC
29650-1270
US

IV. Provider business mailing address

439 S BUNCOMBE RD APT 501
GREER SC
29650-1270
US

V. Phone/Fax

Practice location:
  • Phone: 864-567-5949
  • Fax:
Mailing address:
  • Phone: 864-567-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LAKEKO BUCKLEY
Title or Position: CEO
Credential:
Phone: 864-567-5949