# MIRACLE MILE MEDICAL CENTER, LLC

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

## Provider details

- **NPI number:** 1184773202
- **Authorized official:** MR. JAMES K. THEIRING (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (323) 556-3942

## Contact information

- **Practice address:** 6000 SAN VICENTE BLVD, LOS ANGELES, CA 90036-4404
- **Practice address phone:** (323) 930-1040
- **Practice address fax:** (323) 937-0525
- **Mailing address:** PO BOX 17358, ENCINO, CA 91416-7358
- **Mailing address phone:** (323) 930-1040
- **Mailing address fax:** (323) 937-0525

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 930000143 | CA | Yes |

## Other

- **Enumeration date:** 01/09/2007
- **Last updated:** 06/30/2008