Provider Demographics
NPI:1649738105
Name:A&G MIRACLE HOME CARE LLC
Entity type:Organization
Organization Name:A&G MIRACLE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENNIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-618-7369
Mailing Address - Street 1:340 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-3101
Mailing Address - Country:US
Mailing Address - Phone:731-618-7369
Mailing Address - Fax:
Practice Address - Street 1:107 N HALL ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:TN
Practice Address - Zip Code:38233-1120
Practice Address - Country:US
Practice Address - Phone:731-618-7369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care