Organization
MIRACLE MILE MEDICAL CENTER
Active
Other names
Miracle Mile Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JORDAN JACKELINI (PRESIDENT)
(310) 905-9682
Entity
Organization
Contact information
Practice address
15910 VENTURA BLVD STE 1719, ENCINO, CA 91436-2838
(310) 905-9682
Mailing address
15910 VENTURA BLVD STE 1719, ENCINO, CA 91436-2838
(310) 905-9682
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
01/26/2024
Last updated
09/19/2024
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