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General NPI Number Information
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NPI Number | 1194842260
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Entity Type | Organization
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Legal Business Name | MIRACLE HOME HEALTH AGENCY INC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 10945 SOUTH STREET #202A
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-653-0668
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Fax | 562-653-0687
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Provider Business Mailing Address
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Address Line | 10945 SOUTH STREET #202A
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-653-0668
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Fax | 562-653-0687
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BERNICE C OSUNWA
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Credential |
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Telephone | 562-653-0668
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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 |
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License Number State | CA
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