Provider Demographics
NPI:1003242942
Name:MIRACLE CARE HOME SERVICES LLC
Entity Type:Organization
Organization Name:MIRACLE CARE HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-982-1909
Mailing Address - Street 1:PO BOX 9166
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39286-9166
Mailing Address - Country:US
Mailing Address - Phone:601-982-1909
Mailing Address - Fax:601-982-8177
Practice Address - Street 1:5120 GALAXIE DR
Practice Address - Street 2:SUITE-B
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4308
Practice Address - Country:US
Practice Address - Phone:601-982-1909
Practice Address - Fax:601-982-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care