Provider Demographics
NPI:1184317141
Name:HOUSE OF MIRACLES, INC.
Entity type:Organization
Organization Name:HOUSE OF MIRACLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LASAC
Authorized Official - Phone:602-488-8880
Mailing Address - Street 1:10720 W INDIAN SCHOOL RD # 19-245
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5721
Mailing Address - Country:US
Mailing Address - Phone:623-203-7381
Mailing Address - Fax:
Practice Address - Street 1:1951 W CAMELBACK RD # 255
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3403
Practice Address - Country:US
Practice Address - Phone:623-203-7381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management