# MIRACLES1ST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043630924
- **Authorized official:** PATRICE WYNNE-FINLEY (GOVERNING BODY)
- **Authorized official phone:** (753) 528-5431

## Contact information

- **Practice address:** 5128 4TH ST NE, COLUMBIA HEIGHTS, MN 55421-2874
- **Practice address phone:** (763) 528-5431
- **Mailing address:** 5128 4TH ST NE, COLUMBIA HEIGHTS, MN 55421-2874
- **Mailing address phone:** (763) 528-5431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 04/18/2014
- **Last updated:** 04/18/2014