Provider Demographics
NPI:1699655563
Name:MIRACLE OF HEALTH HOLISTIC SERVICES, LLC
Entity type:Organization
Organization Name:MIRACLE OF HEALTH HOLISTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-851-2631
Mailing Address - Street 1:81 STATE ROUTE 9H
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-3825
Mailing Address - Country:US
Mailing Address - Phone:518-851-2631
Mailing Address - Fax:518-851-6631
Practice Address - Street 1:81 STATE ROUTE 9H
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-3825
Practice Address - Country:US
Practice Address - Phone:518-851-2631
Practice Address - Fax:518-851-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service