Provider Demographics
NPI:1922618859
Name:MIRANDA HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:MIRANDA HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAKAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-922-3710
Mailing Address - Street 1:19150 S KEDZIE AVE
Mailing Address - Street 2:203
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422
Mailing Address - Country:US
Mailing Address - Phone:708-922-3710
Mailing Address - Fax:708-922-3715
Practice Address - Street 1:19150 S KEDZIE AVE
Practice Address - Street 2:203
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422
Practice Address - Country:US
Practice Address - Phone:708-922-3710
Practice Address - Fax:708-922-3715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRANDA HOME HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-05
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care