MEDICARE: MIRACLE CARE HOSPICE, INC.

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	251G00000X	Community Based Hospice Care Agency	087	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871648758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE CARE HOSPICE, INC.

Provider Business Mailing Address
First Line	:	330 EDGEWOOD TERRACE DR
Second Line	:	SUITE B
City	:	JACKSON
State	:	MS
Zip	:	39206-6216
Country	:	US
Telephone Number	:	601-982-1909
Fax Number	:	601-982-8177

Provider Business Practice Location Address
First Line	:	330 EDGEWOOD TERRACE DR
Second Line	:	SUITE B
City	:	JACKSON
State	:	MS
Zip	:	39206-6216
Country	:	US
Telephone Number	:	601-982-1909
Fax Number	:	601-982-8177

Authorized Official
Title or Position	:	CEO
Name	:	MR. EDDIE LEE JR.
Credential	:
Telephone Number	:	601-982-1909

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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