Provider Demographics
NPI:1750652798
Name:MIRACLE LIFE ADULT DAY CARE CENTER LLC
Entity Type:Organization
Organization Name:MIRACLE LIFE ADULT DAY CARE CENTER LLC
Other - Org Name:MIRACLE LIFE ADULT DAY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-423-0800
Mailing Address - Street 1:5400 S BISCAYNE DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1932
Mailing Address - Country:US
Mailing Address - Phone:941-423-0800
Mailing Address - Fax:941-423-6421
Practice Address - Street 1:5400 S BISCAYNE DR
Practice Address - Street 2:SUITE F
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1932
Practice Address - Country:US
Practice Address - Phone:941-423-0800
Practice Address - Fax:941-423-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9189311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home