Provider Demographics
NPI:1902514458
Name:MIRACLE AND BEHAVIOR MIAMI LLC
Entity Type:Organization
Organization Name:MIRACLE AND BEHAVIOR MIAMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YESSIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOADA HUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-720-8472
Mailing Address - Street 1:11336 SW 71ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11336 SW 71ST LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1970
Practice Address - Country:US
Practice Address - Phone:786-720-8472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty