Provider Demographics
NPI:1063826436
Name:MINI MIRACLES PEDIATRIC DAY HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:MINI MIRACLES PEDIATRIC DAY HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-368-8996
Mailing Address - Street 1:120 EAGLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241
Mailing Address - Country:US
Mailing Address - Phone:318-368-8996
Mailing Address - Fax:318-368-8997
Practice Address - Street 1:120 EAGLE POINT DR
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241
Practice Address - Country:US
Practice Address - Phone:318-368-8681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization