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General NPI Number Information
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NPI Number | 1427937903
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Entity Type | Organization
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Legal Business Name | JEFFERY'S MIRACLE HOME CARE LLC
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 3910 INDUSTRAIL BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46254
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Country | US
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Telephone | 317-794-9168
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Fax |
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Provider Business Mailing Address
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Address Line | 3910 INDUSTRIAL BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-2510
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Country | US
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Telephone | 317-794-9168
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON MCBRIDE
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Credential |
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Telephone | 317-794-6198
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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 |
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