Provider Demographics
NPI:1922265586
Name:LORETTA'S LITTLE MIRACLES
Entity Type:Organization
Organization Name:LORETTA'S LITTLE MIRACLES
Other - Org Name:BAKER HICKS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-226-1225
Mailing Address - Street 1:4747 N 1ST ST STE 181
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0517
Mailing Address - Country:US
Mailing Address - Phone:559-226-1225
Mailing Address - Fax:
Practice Address - Street 1:4747 N 1ST ST STE 181
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0517
Practice Address - Country:US
Practice Address - Phone:559-226-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550001075OtherSTATE OF CALIFORNIA DEPT. OF PUBLIC HEALTH LICENSE