Organization
MIRACLE CARE LLC
Active
Other names
miracle home care
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY LYNN SPENCER REGISTERED NURSE (CEO/ ADMINISTRATOR)
(586) 549-4642
Entity
Organization
Contact information
Practice address
2727 2ND AVE STE 315, DETROIT, MI 48201-2675
(313) 974-6480
Mailing address
2727 2ND AVE, SUITE 315, DETROIT, MI 48201-2658
(313) 974-6480
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23-9257
MEDICARE PTAN
MI
Enumeration date
10/20/2010
Last updated
01/11/2013
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