| Miracle Mile Medical Center | |
|
15910 Ventura Blvd Ste 1719 Encino CA 91436-2838 | |
| (310) 905-9682 | |
| Not Available |
| Full Name | Miracle Mile Medical Center |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 15910 Ventura Blvd Ste 1719, Encino, California |
| Authorized Official Name and Position | Jordan Jackelini (PRESIDENT) |
| Authorized Official Contact | 3109059682 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Miracle Mile Medical Center 15910 Ventura Blvd Ste 1719 Encino CA 91436-2838 Ph: (310) 905-9682 | Miracle Mile Medical Center 15910 Ventura Blvd Ste 1719 Encino CA 91436-2838 Ph: (310) 905-9682 |
| NPI Number | 1174385934 |
|---|---|
| Provider Enumeration Date | 01/26/2024 |
| Last Update Date | 09/19/2024 |
| Certification Date | 09/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174385934 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
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