Provider Demographics
NPI:1568762235
Name:MINNIE'S MIRACLES
Entity Type:Organization
Organization Name:MINNIE'S MIRACLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-223-2626
Mailing Address - Street 1:1 MARION AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-7920
Mailing Address - Country:US
Mailing Address - Phone:740-233-2626
Mailing Address - Fax:740-223-2727
Practice Address - Street 1:1 MARION AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-7920
Practice Address - Country:US
Practice Address - Phone:740-233-2626
Practice Address - Fax:740-223-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health