Provider Demographics
NPI:1437636966
Name:MIRACLE HEALTHCARE LLC
Entity Type:Organization
Organization Name:MIRACLE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-769-0196
Mailing Address - Street 1:20901 CORINTH RD
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1872
Mailing Address - Country:US
Mailing Address - Phone:773-573-9843
Mailing Address - Fax:
Practice Address - Street 1:2024 HICKORY RD STE 306
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430
Practice Address - Country:US
Practice Address - Phone:773-573-9843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000553251E00000X, 251J00000X, 261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA