Organization
MIRACLES1ST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICE WYNNE-FINLEY (GOVERNING BODY)
(753) 528-5431
Entity
Organization
Contact information
Practice address
5128 4TH ST NE, COLUMBIA HEIGHTS, MN 55421-2874
(763) 528-5431
Mailing address
5128 4TH ST NE, COLUMBIA HEIGHTS, MN 55421-2874
(763) 528-5431
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
04/18/2014
Last updated
04/18/2014
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