# MIRACLE ON 29TH STREET

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Koala-D Meds
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255835997
- **Authorized official:** MR. TROY BERKLEY (OWNER)
- **Authorized official phone:** (480) 302-1101

## Contact information

- **Practice address:** 18210 N 29TH ST, PHOENIX, AZ 85032-1103
- **Practice address phone:** (480) 302-1101
- **Mailing address:** 18210 N 29TH ST, PHOENIX, AZ 85032-1103
- **Mailing address phone:** (480) 302-1101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | AL10509H | AZ | Yes |

## Other

- **Enumeration date:** 03/19/2018
- **Last updated:** 09/12/2025