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General NPI Number Information
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NPI Number | 1093059453
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Entity Type | Organization
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Legal Business Name | MIRANDA HOME HEALTH CARE INC
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Dates
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Enumeration Date | 11/23/2012
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 2644 DEMPSTER ST STE 101A
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City | PARK RIDGE
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State | IL
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Zip | 60068-8430
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Country | US
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Telephone | 708-922-3710
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Fax | 708-922-3715
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Provider Business Mailing Address
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Address Line | 19150 S. KEDZIE AVE 203
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City | FLOSSMOOR
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State | IL
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Zip | 60422-1222
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | INSIA TABREZI
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Credential |
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Telephone | 630-880-6246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | IL
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