Healthcare Provider Details

I. General information

NPI: 1952615635
Provider Name (Legal Business Name): MIRACLES BEHAVIORAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 ARBORETUM PKWY STE 365
RICHMOND VA
23236-3493
US

IV. Provider business mailing address

9100 ARBORETUM PKWY STE 365
RICHMOND VA
23236-3493
US

V. Phone/Fax

Practice location:
  • Phone: 804-400-6479
  • Fax:
Mailing address:
  • Phone: 804-400-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VALERIE WILLIAMS
Title or Position: PRESIDENT
Credential: MSW
Phone: 804-400-6479