Provider Demographics
NPI:1003433145
Name:MIRACLE GROUP LLC
Entity Type:Organization
Organization Name:MIRACLE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FAVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-535-9488
Mailing Address - Street 1:7713 MILLER FALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1127
Mailing Address - Country:US
Mailing Address - Phone:301-535-9488
Mailing Address - Fax:301-987-7223
Practice Address - Street 1:7713 MILLER FALL RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-1127
Practice Address - Country:US
Practice Address - Phone:301-535-9488
Practice Address - Fax:301-987-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals