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General NPI Number Information
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NPI Number | 1215268016
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Entity Type | Organization
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Legal Business Name | MIRACLE CARE HOME HEALTH AGENCY CORP.
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 5400 S BISCAYNE DR SUITE D
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City | NORTH PORT
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State | FL
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Zip | 34287-1932
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Country | US
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Telephone | 305-744-2397
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7485
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City | NORTH PORT
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State | FL
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Zip | 34290-0485
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Country | US
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Telephone | 305-744-2397
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MARINA CHEMERISOV
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Credential |
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Telephone | 305-744-2397
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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 | FL
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