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General NPI Number Information
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NPI Number | 1710740097
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Entity Type | Organization
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Legal Business Name | MIRACLES OF A SECOND CHANCE INC
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Dates
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Enumeration Date | 01/31/2024
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 507 19TH TER
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City | BISBEE
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State | AZ
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Zip | 85603-1705
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Country | US
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Telephone | 520-255-2158
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1002
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City | BISBEE
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State | AZ
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Zip | 85603-2002
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Country | US
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Telephone | 520-266-8906
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Fax |
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | ALMA HICKMAN
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Credential |
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Telephone | 520-266-8906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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