Provider Demographics
NPI:1144026188
Name:MIRACLE CARE MANOR LLC
Entity type:Organization
Organization Name:MIRACLE CARE MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PETRONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-444-8987
Mailing Address - Street 1:9390 APPLETON
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1240
Mailing Address - Country:US
Mailing Address - Phone:734-444-8987
Mailing Address - Fax:
Practice Address - Street 1:9390 APPLETON
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1240
Practice Address - Country:US
Practice Address - Phone:734-444-8987
Practice Address - Fax:734-725-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home