Provider Demographics
NPI:1417441684
Name:MIRACLE HANDS HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MIRACLE HANDS HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEPI
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSTIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-939-2928
Mailing Address - Street 1:605 CALLE JUAREZ
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6816 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-2634
Practice Address - Country:US
Practice Address - Phone:216-622-5741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23806251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health