Provider Demographics
NPI:1336469717
Name:MIRACLES LLC
Entity Type:Organization
Organization Name:MIRACLES LLC
Other - Org Name:HAIRGAZM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-504-1927
Mailing Address - Street 1:111 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-1514
Mailing Address - Country:US
Mailing Address - Phone:856-338-1030
Mailing Address - Fax:
Practice Address - Street 1:111 N 4TH ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1514
Practice Address - Country:US
Practice Address - Phone:856-338-1030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service