Provider Demographics
NPI:1912131350
Name:MIRACLE MOBILITY INC
Entity type:Organization
Organization Name:MIRACLE MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAKWENZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-675-0108
Mailing Address - Street 1:4311 W 147TH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1573
Mailing Address - Country:US
Mailing Address - Phone:310-675-0108
Mailing Address - Fax:
Practice Address - Street 1:4311 W 147TH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1573
Practice Address - Country:US
Practice Address - Phone:310-675-0108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51817332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6523810001Medicare NSC