Provider Demographics
NPI:1710527296
Name:KIDS MIRACLE STEPS, INC.
Entity Type:Organization
Organization Name:KIDS MIRACLE STEPS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLYACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-662-8658
Mailing Address - Street 1:1371-1381 N PALM AVE.
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-505-4937
Mailing Address - Fax:
Practice Address - Street 1:1371-1381 N PALM AVE.
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-505-4937
Practice Address - Fax:954-212-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105261500Medicaid