Provider Demographics
NPI:1083845440
Name:MIRACLE HEALTH CARE SERVICES ,INC
Entity Type:Organization
Organization Name:MIRACLE HEALTH CARE SERVICES ,INC
Other - Org Name:AMERICAN INVESTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCAS JOEL
Authorized Official - Middle Name:KAHUMBA
Authorized Official - Last Name:MOSHI
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:202-470-8092
Mailing Address - Street 1:6856 EASTERN AVE NW
Mailing Address - Street 2:SUITE 303 ,NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2165
Mailing Address - Country:US
Mailing Address - Phone:202-558-6600
Mailing Address - Fax:202-558-6359
Practice Address - Street 1:6856 EASTERN AVE NW
Practice Address - Street 2:SUITE 303 ,NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2165
Practice Address - Country:US
Practice Address - Phone:202-558-6600
Practice Address - Fax:202-558-6359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC0136251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health