# MIRACLE COMMUNITY BEHAVIORAL CENTER CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MIRACLE MEDICAL CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700491552
- **Authorized official:** BRISAIDA DUARTE (CEO)
- **Authorized official phone:** (786) 697-1150

## Contact information

- **Practice address:** 15660 SW 72ND ST, MIAMI, FL 33193-1923
- **Practice address phone:** (786) 697-1150
- **Mailing address:** 15660 SW 72ND ST, MIAMI, FL 33193-1923
- **Mailing address phone:** (786) 697-1150

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | — | — |
| 225200000X | Physical Therapy Assistant | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | — | — | — |

## Other

- **Enumeration date:** 09/09/2020
- **Last updated:** 08/25/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 118354400 | — | FL |
| 01 | — | 15527884 | CAQH | FL |
| 01 | — | 42711 | HEALTH CARE CLINIC CERTIFICATE (AHCA) | FL |