Provider Demographics
NPI:1740383926
Name:MIRACLE HOME CARE, INC.
Entity Type:Organization
Organization Name:MIRACLE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-593-9908
Mailing Address - Street 1:30555 SOUTHFIELD RD STE 170
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7700
Mailing Address - Country:US
Mailing Address - Phone:248-593-9908
Mailing Address - Fax:248-593-9967
Practice Address - Street 1:30555 SOUTHFIELD RD STE 170
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-7700
Practice Address - Country:US
Practice Address - Phone:248-593-9908
Practice Address - Fax:248-593-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237518Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER