Provider Demographics
NPI:1093435356
Name:MIRACLE HOME CARE SERVICES
Entity Type:Organization
Organization Name:MIRACLE HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KORASSA
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:240-706-6831
Mailing Address - Street 1:13017 BROADMORE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3116
Mailing Address - Country:US
Mailing Address - Phone:240-706-6831
Mailing Address - Fax:
Practice Address - Street 1:13017 BROADMORE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3116
Practice Address - Country:US
Practice Address - Phone:240-706-6831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility