Provider Demographics
NPI:1184440216
Name:MIRACLE MENTAL HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:MIRACLE MENTAL HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRONNAH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:973-609-7069
Mailing Address - Street 1:58 ARSDALE TER
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2304
Mailing Address - Country:US
Mailing Address - Phone:973-609-7069
Mailing Address - Fax:
Practice Address - Street 1:58 ARSDALE TER
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2304
Practice Address - Country:US
Practice Address - Phone:973-609-7069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty