Provider Demographics
NPI:1144862657
Name:MIRACLEHOMEHEALTHSOLUTIONS LLC
Entity type:Organization
Organization Name:MIRACLEHOMEHEALTHSOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLAMIDE
Authorized Official - Middle Name:IYANU
Authorized Official - Last Name:BANKOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-210-5377
Mailing Address - Street 1:20 CAROL AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3502
Mailing Address - Country:US
Mailing Address - Phone:443-210-5377
Mailing Address - Fax:
Practice Address - Street 1:20 CAROL AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3502
Practice Address - Country:US
Practice Address - Phone:443-210-5377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty