Organization
MIRACLES IN A BAG
Active
Parent organization
MIRACLE IN A BAG
Other names
None
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIRACLE IN A BAG
Authorized official
MS. JERRILYN M BOYD-HADLEY I LLC (OWNER CEO)
(615) 944-9851
Entity
Organization
Contact information
Practice address
320 OLD HICKORY BLVD APT 3008, UNIT 3008, NASHVILLE, TN 37221-1413
(615) 944-9851
Mailing address
320 OLD HICKORY BLVD APT 3008, UNIT 3008, NASHVILLE, TN 37221-1413
(615) 944-9851
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
1000000010607
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301400000X
—
TN
Enumeration date
09/21/2012
Last updated
09/21/2012
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