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General NPI Number Information
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NPI Number | 1437636966
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Entity Type | Organization
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Legal Business Name | MIRACLE HEALTHCARE LLC
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 2024 HICKORY RD STE 306
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City | HOMEWOOD
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State | IL
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Zip | 60430
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Country | US
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Telephone | 773-573-9843
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Fax |
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Provider Business Mailing Address
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Address Line | 20901 CORINTH RD
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1872
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Country | US
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Telephone | 773-573-9843
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DALE MUHAMMAD
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Credential | RN
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Telephone | 708-769-0196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | 4000553
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 4000553
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 4000553
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License Number State | IL
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