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General NPI Number Information
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NPI Number | 1003519273
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Entity Type | Organization
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Legal Business Name | MIRAKELL L.L.C.
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 1445 SILVERTON DR
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City | BATON ROUGE
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State | LA
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Zip | 70815-5363
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Country | US
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Telephone | 225-475-0009
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 SILVERTON DR
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City | BATON ROUGE
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State | LA
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Zip | 70815-5363
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Country | US
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Telephone | 225-475-0009
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIKIEL THOMAS
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Credential |
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Telephone | 225-475-0009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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