Provider Demographics
NPI:1386264190
Name:MIRANDA HOME CARE LLC
Entity type:Organization
Organization Name:MIRANDA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-304-1513
Mailing Address - Street 1:28229 E BORIS ST
Mailing Address - Street 2:
Mailing Address - City:WELLTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85356-6651
Mailing Address - Country:US
Mailing Address - Phone:928-304-1513
Mailing Address - Fax:
Practice Address - Street 1:28229 E BORIS ST
Practice Address - Street 2:
Practice Address - City:WELLTON
Practice Address - State:AZ
Practice Address - Zip Code:85356-6651
Practice Address - Country:US
Practice Address - Phone:928-304-1513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care