Provider Demographics
NPI:1760183602
Name:MIRACLE HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:MIRACLE HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:MATEO
Authorized Official - Last Name:BACCAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:818-267-7945
Mailing Address - Street 1:3311 S RAINBOW BLVD STE 129
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6208
Mailing Address - Country:US
Mailing Address - Phone:702-268-8112
Mailing Address - Fax:702-268-8915
Practice Address - Street 1:3311 S RAINBOW BLVD STE 129
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6208
Practice Address - Country:US
Practice Address - Phone:702-268-8112
Practice Address - Fax:702-268-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based