MEDICARE: MIRACLE TOUCH HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1275284408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE TOUCH HOME CARE LLC

Provider Business Mailing Address
First Line	:	223 E CITY HALL AVE STE 353
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-1723
Country	:	US
Telephone Number	:	757-597-1202
Fax Number	:	757-299-8091

Provider Business Practice Location Address
First Line	:	223 E CITY HALL AVE STE 353
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-1723
Country	:	US
Telephone Number	:	757-597-1202
Fax Number	:	757-299-8091

Authorized Official
Title or Position	:	OWNER
Name	:	SHAUNICE RICHARDSON
Credential	:
Telephone Number	:	757-597-1202

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	08/23/2022

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