| Miracle Care Home Services Llc | |
|
5120 Galaxie Dr Suite-b Jackson MS 39206-4308 | |
| (601) 982-1909 | |
| (601) 982-8177 |
| Full Name | Miracle Care Home Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5120 Galaxie Dr, Jackson, Mississippi |
| Authorized Official Name and Position | Eddie Lee (PRESIDENT/CEO) |
| Authorized Official Contact | 6019821909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miracle Care Home Services Llc Po Box 9166 Jackson MS 39286-9166 Ph: (601) 982-1909 | Miracle Care Home Services Llc 5120 Galaxie Dr Suite-b Jackson MS 39206-4308 Ph: (601) 982-1909 |
| NPI Number | 1003242942 |
|---|---|
| Provider Enumeration Date | 09/24/2013 |
| Last Update Date | 09/24/2013 |
| Medicare PECOS PAC ID | 3971736497 |
|---|---|
| Medicare Enrollment ID | O20140507000436 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003242942 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 253Z00000X | In Home Supportive Care | (* (Not Available)) | Secondary |
| Provider Name | Rosie L Walker-mcnair |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124109871 PECOS PAC ID: 3072564947 Enrollment ID: I20050208000780 |
| Provider Name | Maxie Lerone Gordon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427018613 PECOS PAC ID: 2466406798 Enrollment ID: I20050309000456 |
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