Organization
MIRACLES SUPPORTIVE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNISCIA MONIQUE SHERROD (CHIEF EXECUTIVE OFFICER)
(252) 885-3347
Entity
Organization
Contact information
Practice address
217 N MAIN ST, 204, TARBORO, NC 27886-5054
(252) 314-5141
Mailing address
217 N MAIN ST, 204, TARBORO, NC 27886-5054
(252) 314-5141
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/21/2009
Last updated
11/19/2009
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