Provider Demographics
NPI:1598780454
Name:MIRACLE HEALTH CARE, INC
Entity Type:Organization
Organization Name:MIRACLE HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERESETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-989-8878
Mailing Address - Street 1:3245 E LIVINGSTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1943
Mailing Address - Country:US
Mailing Address - Phone:614-237-7702
Mailing Address - Fax:614-235-5383
Practice Address - Street 1:3245 E LIVINGSTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1943
Practice Address - Country:US
Practice Address - Phone:614-237-7702
Practice Address - Fax:614-235-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2442431Medicaid
OH368032Medicare PIN