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General NPI Number Information
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NPI Number | 1063826436
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Entity Type | Organization
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Legal Business Name | MINI MIRACLES PEDIATRIC DAY HEALTH CENTER, LLC
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 120 EAGLE POINT DR
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City | FARMERVILLE
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State | LA
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Zip | 71241
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Country | US
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Telephone | 318-368-8681
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Fax |
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Provider Business Mailing Address
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Address Line | 120 EAGLE POINT DR
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City | FARMERVILLE
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State | LA
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Zip | 71241
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Country | US
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Telephone | 318-368-8996
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Fax | 318-368-8997
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | HALEY AUGER
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Credential |
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Telephone | 318-368-8996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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