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General NPI Number Information
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NPI Number | 1245533777
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Entity Type | Organization
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Legal Business Name | TOTAL MIRACLE KIDS
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 212 W SECOND AVE STE F
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City | GASTONIA
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State | NC
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Zip | 28052-4055
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Country | US
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Telephone | 704-854-8399
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Fax | 704-854-8410
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Provider Business Mailing Address
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Address Line | 212 W SECOND AVE STE F
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City | GASTONIA
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State | NC
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Zip | 28052-4055
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Country | US
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Telephone | 704-854-8399
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Fax | 704-854-8410
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. TIFFANY KENDALL
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Credential |
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Telephone | 704-854-8399
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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 | HC4236
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License Number State | NC
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