# MIRACLE HOME HEALTH OF WISCONSIN INC

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

## Provider details

- **NPI number:** 1851667703
- **Authorized official:** MS. ARKADIY KOPSHTEYN MBA (CEO/OWNER)
- **Authorized official phone:** (414) 797-2254

## Contact information

- **Practice address:** 7545 N PORT WASHINGTON RD STE 3, GLENDALE, WI 53217-3422
- **Practice address phone:** (414) 797-2254
- **Practice address fax:** (888) 910-5128
- **Mailing address:** 7545 N PORT WASHINGTON RD STE 3, GLENDALE, WI 53217-3422
- **Mailing address phone:** (414) 915-0838
- **Mailing address fax:** (414) 797-4544

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 1174 | WI | Yes |

## Other

- **Enumeration date:** 03/26/2012
- **Last updated:** 10/24/2023