Provider Demographics
NPI:1689096984
Name:MIRACLE CONSULTING
Entity Type:Organization
Organization Name:MIRACLE CONSULTING
Other - Org Name:BEHAVIORAL GROUP INNOVATIONS(BGI)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:480-593-7203
Mailing Address - Street 1:4903 E DIXON CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6453
Mailing Address - Country:US
Mailing Address - Phone:480-593-7203
Mailing Address - Fax:
Practice Address - Street 1:5225 N 19TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2903
Practice Address - Country:US
Practice Address - Phone:480-593-7203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRACLE CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health