Provider Demographics
NPI:1952088205
Name:MIRACLE CARE DMEPOS
Entity Type:Organization
Organization Name:MIRACLE CARE DMEPOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JATTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-688-7661
Mailing Address - Street 1:204 JEFFERSON ST N
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1371
Mailing Address - Country:US
Mailing Address - Phone:612-688-7661
Mailing Address - Fax:612-688-7672
Practice Address - Street 1:204 JEFFERSON ST N
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1371
Practice Address - Country:US
Practice Address - Phone:612-688-7661
Practice Address - Fax:612-688-7672
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRACLE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-29
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies