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General NPI Number Information
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NPI Number | 1578085833
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Entity Type | Organization
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Legal Business Name | MIRACLE HOME CARE
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2200 E WOLVERINE CIR
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City | WASILLA
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State | AK
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Zip | 99654-2708
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Country | US
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Telephone | 907-357-0078
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 E WOLVERINE CIR
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City | WASILLA
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State | AK
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Zip | 99654-2708
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Country | US
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Telephone | 907-357-0078
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | MILAGROS PASARABA RAGLAND
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Credential |
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Telephone | 907-357-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 101178
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License Number State | AK
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