Organization
A'MIRACLE CONSUMER DIRECTED SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VENOLIA ANTIONETTE THOMAS (CEO/VENDOR)
(314) 649-7736
Entity
Organization
Contact information
Practice address
3159 FEE FEE RD STE 215, BRIDGETON, MO 63044-3299
(314) 649-7736
(314) 528-5294
Mailing address
3161 FEE FEE RD STE A, BRIDGETON, MO 63044-3206
(314) 649-7736
(314) 738-9941
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
MO
Other
Enumeration date
11/09/2017
Last updated
03/20/2020
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