Provider Demographics
NPI:1700214822
Name:MIRACLE HANDS HOME CARE
Entity Type:Organization
Organization Name:MIRACLE HANDS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAKEKO
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-567-5949
Mailing Address - Street 1:439 S BUNCOMBE RD APT 501
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1270
Mailing Address - Country:US
Mailing Address - Phone:864-567-5949
Mailing Address - Fax:
Practice Address - Street 1:439 S BUNCOMBE RD APT 501
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1270
Practice Address - Country:US
Practice Address - Phone:864-567-5949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health