Provider Demographics
NPI:1710352455
Name:MIRACLES HOUSE INC.
Entity Type:Organization
Organization Name:MIRACLES HOUSE INC.
Other - Org Name:AMAZING WONDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:954-383-3267
Mailing Address - Street 1:13211 NW 26TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-1333
Mailing Address - Country:US
Mailing Address - Phone:786-502-8532
Mailing Address - Fax:772-212-7122
Practice Address - Street 1:13211 NW 26TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-1333
Practice Address - Country:US
Practice Address - Phone:786-502-8532
Practice Address - Fax:772-212-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12756310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003284700Medicaid