Provider Demographics
NPI:1659104974
Name:MIRACLE CARE, INC.
Entity type:Organization
Organization Name:MIRACLE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EZIRIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-839-7690
Mailing Address - Street 1:5560 FRANKLIN PIKE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5797
Mailing Address - Country:US
Mailing Address - Phone:615-839-7690
Mailing Address - Fax:
Practice Address - Street 1:5560 FRANKLIN PIKE CIR STE 100
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5797
Practice Address - Country:US
Practice Address - Phone:615-839-7690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care