MEDICARE: MIRACLES HOME CARE AGENCY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	385H00000X	Respite Care
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1669166823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLES HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	2748 HELLERMAN ST SIDE B
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2939
Country	:	US
Telephone Number	:	267-961-5801
Fax Number	:	888-883-2366

Provider Business Practice Location Address
First Line	:	2748 HELLERMAN ST SIDE B
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2939
Country	:	US
Telephone Number	:	267-961-5801
Fax Number	:	888-883-2366

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	SOKOL SERJANI
Credential	:	CRNP, FNP-C
Telephone Number	:	267-961-5801

Provider Enumeration Date	:	06/08/2023
Last Update Date	:	06/08/2023

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