Provider Demographics
NPI:1851576250
Name:A SMALL MIRACLE, INC.
Entity Type:Organization
Organization Name:A SMALL MIRACLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PRESSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-751-9089
Mailing Address - Street 1:2110 FORT BRAGG RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-7042
Mailing Address - Country:US
Mailing Address - Phone:910-672-0272
Mailing Address - Fax:
Practice Address - Street 1:2110 FORT BRAGG RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7042
Practice Address - Country:US
Practice Address - Phone:910-672-0272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408797Medicaid