Provider Demographics
NPI:1669734349
Name:MIRACLE CHILREN INC.
Entity type:Organization
Organization Name:MIRACLE CHILREN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSANG
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:347-858-6537
Mailing Address - Street 1:18908 MANGIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2320
Mailing Address - Country:US
Mailing Address - Phone:347-858-6537
Mailing Address - Fax:
Practice Address - Street 1:18908 MANGIN AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2320
Practice Address - Country:US
Practice Address - Phone:347-858-6537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174847021302F00000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty