Provider Demographics
NPI:1316312218
Name:A PLACE FOR MIRACLES LIVING CENTER LLC
Entity type:Organization
Organization Name:A PLACE FOR MIRACLES LIVING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-788-3068
Mailing Address - Street 1:5100 N 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5219
Mailing Address - Country:US
Mailing Address - Phone:414-788-3068
Mailing Address - Fax:414-438-9436
Practice Address - Street 1:7022 N 43RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-2219
Practice Address - Country:US
Practice Address - Phone:414-788-3068
Practice Address - Fax:414-438-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities