Provider Demographics
NPI:1871184408
Name:GRACE MIRACLE HOME CARE LLC
Entity Type:Organization
Organization Name:GRACE MIRACLE HOME CARE LLC
Other - Org Name:GRACE MIRACLE HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-257-1079
Mailing Address - Street 1:3604 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2524
Mailing Address - Country:US
Mailing Address - Phone:302-257-1079
Mailing Address - Fax:302-762-1647
Practice Address - Street 1:3604 MILLER RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2524
Practice Address - Country:US
Practice Address - Phone:302-257-1079
Practice Address - Fax:302-762-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health