Healthcare Provider Details

I. General information

NPI: 1336713544
Provider Name (Legal Business Name): MIRACLES OF LOVE HEALTH AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9747 WHITEHURST DR
DALLAS TX
75243-8773
US

IV. Provider business mailing address

9747 WHITEHURST DR
DALLAS TX
75243-8773
US

V. Phone/Fax

Practice location:
  • Phone: 214-497-2037
  • Fax:
Mailing address:
  • Phone: 214-497-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. RADONICA STEWARD
Title or Position: ADMINISTRATOR
Credential: LVN
Phone: 214-497-2037