Provider Demographics
NPI:1801025564
Name:DIVINE MIRACLES, INC.
Entity Type:Organization
Organization Name:DIVINE MIRACLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-669-4341
Mailing Address - Street 1:2626 CHARLES DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-3779
Mailing Address - Country:US
Mailing Address - Phone:504-322-2375
Mailing Address - Fax:504-322-2414
Practice Address - Street 1:2626 CHARLES DR
Practice Address - Street 2:SUITE G
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-3779
Practice Address - Country:US
Practice Address - Phone:504-322-2375
Practice Address - Fax:504-322-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care