Provider Demographics
NPI:1780161000
Name:MIRACLE HILL NURSING AND REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:MIRACLE HILL NURSING AND REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:AIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-661-9779
Mailing Address - Street 1:1329 ABRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-1907
Mailing Address - Country:US
Mailing Address - Phone:850-224-8486
Mailing Address - Fax:850-224-8815
Practice Address - Street 1:1329 ABRAHAM ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-1907
Practice Address - Country:US
Practice Address - Phone:850-224-8486
Practice Address - Fax:850-224-8815
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-20
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSNF1354096Medicaid