Provider Demographics
NPI:1588276844
Name:MY'RACLE HANDS
Entity type:Organization
Organization Name:MY'RACLE HANDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, BSHCM, MSHS
Authorized Official - Phone:475-655-4159
Mailing Address - Street 1:619 BENHAM ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2656
Mailing Address - Country:US
Mailing Address - Phone:475-655-4159
Mailing Address - Fax:
Practice Address - Street 1:619 BENHAM ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2656
Practice Address - Country:US
Practice Address - Phone:475-655-4159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty