Provider Demographics
NPI:1780629642
Name:MIRACLE HOME HEALTH, INC
Entity Type:Organization
Organization Name:MIRACLE HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-436-5229
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3641
Mailing Address - Country:US
Mailing Address - Phone:972-436-5229
Mailing Address - Fax:214-222-3369
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3641
Practice Address - Country:US
Practice Address - Phone:972-436-5229
Practice Address - Fax:214-222-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011002251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459182Medicare ID - Type UnspecifiedHOME HEALTH