Provider Demographics
NPI:1154567154
Name:MIRACLE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:MIRACLE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNDAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:OMENIHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-395-8701
Mailing Address - Street 1:1802 GARRISON WAY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-1209
Mailing Address - Country:US
Mailing Address - Phone:214-395-8701
Mailing Address - Fax:
Practice Address - Street 1:1802 GARRISON WAY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-1209
Practice Address - Country:US
Practice Address - Phone:214-395-8701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-21
Last Update Date:2008-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health