MEDICARE: MIRACLE HOME CARE II 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1487476529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE HOME CARE II LLC

Provider Business Mailing Address
First Line	:	3725 LINCOLN AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-3521
Country	:	US
Telephone Number	:	314-349-5419
Fax Number	:

Provider Business Practice Location Address
First Line	:	3725 LINCOLN AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-3521
Country	:	US
Telephone Number	:	314-349-5419
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VIRDELL MCGRUDER
Credential	:
Telephone Number	:	314-349-5419

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

Similar Medicare Providers

1407989072 — KRISTINE TERESA OLIVAS MFT
Practice Location Address:

11164 S SAINT LOUIS AVE
CHICAGO, IL
60655-3521

Practice Phone: 773-957-5352
Practice Fax:

1194843268 — LITTLE SISTERS OF THE POOR
Practice Location Address:

3225 N FLORISSANT AVE
SAINT LOUIS, MO
63107-3521

Practice Phone: 314-421-6022
Practice Fax: 314-421-5936

1477759942 — MRS. OLGA VISHNEVETSKY OTR L
Practice Location Address:

3225 N FLORISSANT AVE
SAINT LOUIS, MO
63107-3521

Practice Phone: 314-621-1244
Practice Fax:

1306385380 — MS. MONICA LOUISE MCMAHON M.S. SLP-CF
Practice Location Address:

3225 N FLORISSANT AVE
SAINT LOUIS, MO
63107-3521

Practice Phone: 314-421-6022
Practice Fax:

1912556606 — JPAM CARE & REHABILITATION CENTER, INC
Practice Location Address:

3225 N FLORISSANT AVE
SAINT LOUIS, MO
63107-3521

Practice Phone: 314-374-7419
Practice Fax:

1750309902 — MOLLY ALBERS PT
Practice Location Address:

107 CONCORD PLAZA
ST. LOUIS, MO
63128-3521

Practice Phone: 314-842-2990
Practice Fax: 314-842-5162

Directions to “MIRACLE HOME CARE II LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.