Organization
MIRACLEO OF LOVE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANGUS BRADSHAW JR. (EXECUTIVE DIRECTOR)
(407) 843-1760
Entity
Organization
Contact information
Practice address
741 W COLONIAL DR, ORLANDO, FL 32804-7343
(407) 843-1760
(407) 843-1767
Mailing address
741 W COLONIAL DR, ORLANDO, FL 32804-7343
(407) 843-1760
(407) 843-1767
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FL9220132
—
FL
Enumeration date
04/11/2017
Last updated
04/11/2017
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