Provider Demographics
NPI:1508493891
Name:MIRACLE HOME MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:MIRACLE HOME MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-666-3355
Mailing Address - Street 1:3052 BRIGHTON 1ST ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3052 BRIGHTON 1ST ST APT 4E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8089
Practice Address - Country:US
Practice Address - Phone:310-666-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies