Provider Demographics
NPI:1376386698
Name:MIRACLES OF LOVE HEALTH AGENCY LLC
Entity type:Organization
Organization Name:MIRACLES OF LOVE HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RADONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-497-2037
Mailing Address - Street 1:2351 W NORTHWEST HWY STE 1306
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4433
Mailing Address - Country:US
Mailing Address - Phone:945-321-0629
Mailing Address - Fax:
Practice Address - Street 1:2351 W NORTHWEST HWY STE 1306
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4433
Practice Address - Country:US
Practice Address - Phone:945-321-0629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty