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General NPI Number Information
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NPI Number | 1083845440
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Entity Type | Organization
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Legal Business Name | MIRACLE HEALTH CARE SERVICES ,INC
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 6856 EASTERN AVE NW SUITE 303 ,NW
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City | WASHINGTON
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State | DC
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Zip | 20012-2165
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Country | US
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Telephone | 202-558-6600
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Fax | 202-558-6359
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Provider Business Mailing Address
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Address Line | 6856 EASTERN AVE NW SUITE 303 ,NW
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City | WASHINGTON
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State | DC
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Zip | 20012-2165
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Country | US
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Telephone | 202-558-6600
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Fax | 202-558-6359
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER/OWNER
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Name | MR. LUCAS JOEL KAHUMBA MOSHI SR.
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Credential | MD
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Telephone | 202-470-8092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0136
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License Number State | DC
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