Provider Demographics
NPI:1811466923
Name:MIRACAREGIVERS, LLC
Entity type:Organization
Organization Name:MIRACAREGIVERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BATISLONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-426-0247
Mailing Address - Street 1:1542 KAMEHAMEHA IV RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-2559
Mailing Address - Country:US
Mailing Address - Phone:808-426-0247
Mailing Address - Fax:
Practice Address - Street 1:1542 KAMEHAMEHA IV RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2559
Practice Address - Country:US
Practice Address - Phone:808-426-0247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care