Provider Demographics
NPI:1467755629
Name:MIRACLE HOMEHEALTH CARE LLC
Entity Type:Organization
Organization Name:MIRACLE HOMEHEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-292-0088
Mailing Address - Street 1:711 DEVON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4713
Mailing Address - Country:US
Mailing Address - Phone:847-292-0088
Mailing Address - Fax:847-292-0099
Practice Address - Street 1:711 DEVON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4713
Practice Address - Country:US
Practice Address - Phone:847-292-0088
Practice Address - Fax:847-292-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011278Medicaid