Provider Demographics
NPI:1598325755
Name:MIRAGE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:MIRAGE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:BEVERLY
Authorized Official - Last Name:WEDDERBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-465-4466
Mailing Address - Street 1:1575 MCKEE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-1382
Mailing Address - Country:US
Mailing Address - Phone:302-349-7227
Mailing Address - Fax:302-317-9079
Practice Address - Street 1:1575 MCKEE RD STE 203
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-1382
Practice Address - Country:US
Practice Address - Phone:302-349-7227
Practice Address - Fax:302-317-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health