Provider Demographics
NPI:1386342012
Name:MIRACLE HOME HEALTHCARE, L.L.C
Entity type:Organization
Organization Name:MIRACLE HOME HEALTHCARE, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:443-802-6729
Mailing Address - Street 1:133 N EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3021
Mailing Address - Country:US
Mailing Address - Phone:443-802-6729
Mailing Address - Fax:443-802-6729
Practice Address - Street 1:133 N EDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3021
Practice Address - Country:US
Practice Address - Phone:443-802-6729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health