Provider Demographics
NPI:1487466264
Name:MIRACLE HILL LLC
Entity type:Organization
Organization Name:MIRACLE HILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-653-0916
Mailing Address - Street 1:17561 HILLSIDE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5771
Mailing Address - Country:US
Mailing Address - Phone:917-653-0916
Mailing Address - Fax:888-615-3745
Practice Address - Street 1:187-19 TIOGA DR
Practice Address - Street 2:
Practice Address - City:ST ALDANS
Practice Address - State:NY
Practice Address - Zip Code:11412
Practice Address - Country:US
Practice Address - Phone:917-653-0916
Practice Address - Fax:888-615-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Multi-Specialty