Basic Information
Provider Information
NPI: 1134267081
EntityType: 2
ReplacementNPI:  
OrganizationName: MIRACLE CITY HOSPICE, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: MIRACLE CITY HOSPICE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3021 LORNA RD STE 200
Address2:  
City: HOOVER
State: AL
PostalCode: 352164500
CountryCode: US
TelephoneNumber: 2057256236
FaxNumber: 2053796720
Practice Location
Address1: 9150 S HILLS BLVD STE 100
Address2:  
City: BROADVIEW HEIGHTS
State: OH
PostalCode: 441473511
CountryCode: US
TelephoneNumber: 4403974111
FaxNumber: 4403946099
Other Information
ProviderEnumerationDate: 02/02/2007
LastUpdateDate: 03/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ENGLISH
AuthorizedOfficialFirstName: NORMA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP OF HOSPICE
AuthorizedOfficialTelephone: 2057256236
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: RN
NPICertificationDate: 03/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251G00000X0113HSPOHY AgenciesHospice Care, Community Based 

No ID Information.


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