Provider Demographics
NPI:1821747023
Name:MIRACLE CARE
Entity Type:Organization
Organization Name:MIRACLE CARE
Other - Org Name:MIRACLE DMEPOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JATTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-688-7661
Mailing Address - Street 1:204 JEFFERSON ST N
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1371
Mailing Address - Country:US
Mailing Address - Phone:612-688-7661
Mailing Address - Fax:612-688-7672
Practice Address - Street 1:204 JEFFERSON ST N
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1371
Practice Address - Country:US
Practice Address - Phone:612-688-7661
Practice Address - Fax:612-688-7672
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRACLE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-23
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No253J00000XAgenciesFoster Care AgencyGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Multi-Specialty