Provider Demographics
NPI:1912243668
Name:MIRACLE HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:MIRACLE HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:323-854-2874
Mailing Address - Street 1:6399 WILSHIRE BLVD STE 809
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5711
Mailing Address - Country:US
Mailing Address - Phone:323-782-3883
Mailing Address - Fax:323-782-3841
Practice Address - Street 1:6399 WILSHIRE BLVD STE 809
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5711
Practice Address - Country:US
Practice Address - Phone:323-782-3883
Practice Address - Fax:323-782-3841
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRACLE HOME HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based