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Organization
MIRACLE COMMUNITY BEHAVIORAL CENTER CORP
Active
Organization
MIRACLE COMMUNITY BEHAVIORAL CENTER CORP
Active
Other names
MIRACLE MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
BRISAIDA DUARTE (CEO)
(786) 697-1150
Entity
Organization
Contact information
Practice address
15660 SW 72ND ST, MIAMI, FL 33193-1923
(786) 697-1150
Mailing address
15660 SW 72ND ST, MIAMI, FL 33193-1923
(786) 697-1150
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118354400
—
FL
01
—
15527884
CAQH
FL
01
—
42711
HEALTH CARE CLINIC CERTIFICATE (AHCA)
FL
Enumeration date
09/09/2020
Last updated
08/25/2023
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