Provider Demographics
NPI:1982208336
Name:MIRACLE ADULT DAY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:MIRACLE ADULT DAY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-899-5510
Mailing Address - Street 1:2050 N MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1436
Mailing Address - Country:US
Mailing Address - Phone:909-880-0009
Mailing Address - Fax:909-880-0006
Practice Address - Street 1:2050 N MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1436
Practice Address - Country:US
Practice Address - Phone:909-880-0009
Practice Address - Fax:909-880-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care