Provider Demographics
NPI:1144998014
Name:MERCY & MIRACLE HEALTH SERVICE INC
Entity type:Organization
Organization Name:MERCY & MIRACLE HEALTH SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DM PHD
Authorized Official - Phone:314-401-8028
Mailing Address - Street 1:514 EARTH CITY PLZ STE 312
Mailing Address - Street 2:
Mailing Address - City:EARTH CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63045-1303
Mailing Address - Country:US
Mailing Address - Phone:314-222-8130
Mailing Address - Fax:314-492-0196
Practice Address - Street 1:2065 WALTON RD STE 202
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-5805
Practice Address - Country:US
Practice Address - Phone:314-300-9095
Practice Address - Fax:314-492-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child