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General NPI Number Information
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NPI Number | 1982208336
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Entity Type | Organization
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Legal Business Name | MIRACLE ADULT DAY HEALTH CARE, INC.
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 2050 N MOUNT VERNON AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1436
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Country | US
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Telephone | 909-880-0009
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Fax | 909-880-0006
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Provider Business Mailing Address
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Address Line | 2050 N MOUNT VERNON AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1436
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Country | US
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Telephone | 909-880-0009
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Fax | 909-880-0006
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Authorized Official
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Title or Position | CEO
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Name | FRIDA ZAKARYAN
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Credential |
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Telephone | 323-899-5510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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