Provider Demographics
NPI:1770192569
Name:MIRACLES OF LIFE AT CUTLER BAY, INC
Entity type:Organization
Organization Name:MIRACLES OF LIFE AT CUTLER BAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARNALDO
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:ZAMORA OBREGON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:305-964-5530
Mailing Address - Street 1:10994 SW 184TH ST.
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6615
Mailing Address - Country:US
Mailing Address - Phone:305-964-5530
Mailing Address - Fax:305-290-3384
Practice Address - Street 1:10994 SW 184TH ST.
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6615
Practice Address - Country:US
Practice Address - Phone:305-964-5530
Practice Address - Fax:305-290-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111926100Medicaid