Healthcare Provider Details

I. General information

NPI: 1770729295
Provider Name (Legal Business Name): MIRACLE HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 GARRISON WAY,
GARLAND TX
75040
US

IV. Provider business mailing address

1802 GARRISON WAY,
GARLAND TX
75040
US

V. Phone/Fax

Practice location:
  • Phone: 972-271-5381
  • Fax: 972-271-5724
Mailing address:
  • Phone: 972-271-5381
  • Fax: 972-271-5724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SUNDAY D. OMENIHU
Title or Position: ADMINISTRATOR.
Credential:
Phone: 972-274-5381