Provider Demographics
NPI:1700616273
Name:MIRACLE OF HOPE
Entity type:Organization
Organization Name:MIRACLE OF HOPE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELLYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA CALDERO
Authorized Official - Suffix:
Authorized Official - Credentials:BA, PMB, CFM, RN
Authorized Official - Phone:787-526-5557
Mailing Address - Street 1:#4 CALLE LAS PIEDRAS W1 AVE. DEGETAU BONNEVILLE HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-526-5557
Mailing Address - Fax:
Practice Address - Street 1:#4 CALLE LAS PIEDRAS W1 AVE. DEGETAU BONNEVILLE HEIGHTS
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-526-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier