Provider Demographics
NPI:1457603623
Name:MIRACLE HANDS CARE SERVICES LLC
Entity Type:Organization
Organization Name:MIRACLE HANDS CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RIANET
Authorized Official - Middle Name:ABOUDU
Authorized Official - Last Name:EDIONSERI
Authorized Official - Suffix:
Authorized Official - Credentials:LPN-NURSE
Authorized Official - Phone:301-275-1805
Mailing Address - Street 1:807 SAINT MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1961
Mailing Address - Country:US
Mailing Address - Phone:301-275-1805
Mailing Address - Fax:301-430-7380
Practice Address - Street 1:807 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1961
Practice Address - Country:US
Practice Address - Phone:301-275-1805
Practice Address - Fax:301-430-7380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3317251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health