MIRACLE HOME HEALTH OF WISCONSIN INC (NPI# 1851667703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851667703 |
| Entity Type | Organization |
| Organization Name | MIRACLE HOME HEALTH OF WISCONSIN INC |
| Practice Address |
7665 N Port Washington Rd Ste 102 Glendale WI 53217-3175 |
| Practice Telephone | 4149150838 |
| Practice Fax Number | 4147974544 |
| Mailing Telephone | 4149150838 |
| Mailing Fax Number | 4147974544 |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2019-02-22 |
| Authorized Official Name | MS. ARKADIY KOPSHTEYN (CEO/OWNER) |
| Authorized Official Telephone | 4147972254 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251E00000X | Home Health | 1174 | WI | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 100039227 | 05 |
| Street Address |
7665 N PORT WASHINGTON RD STE 102 |
| City | GLENDALE |
| State | WI |
| Zip Code | 53217-3175 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922632587 | Jasmine Dockery | Pharmacist | 5400 N Port Washington, Glendale, WI 53217 | 2020-02-23 |
| 1174017339 | North Lakes Nursing Home Health Care Agency LLC | Home Health | 225 E Fairmount Ave, Milwaukee, WI 53217 | 2018-06-20 |
| 1083140289 | Miriah Ann King, Ms, Lpc | Counselor | 7805 North Boyd Way, Fox Point, WI 53217 | 2017-05-08 |
| 1245783067 | Lakesha L Jones | Counselor | 5235 N Ironwood Rd, Glendale, WI 53217 | 2016-07-28 |
| 1750783312 | Ibrahim S Abouzeid | Specialist/Technologist, Other | 333 W Brown Deer Road, #240, Milwaukee, WI 53217 | 2014-09-25 |
| 1255733598 | Victoria Gorodetsky | Pharmacist | 229 W Indian Creek Ct, Milwaukee, WI 53217 | 2014-09-18 |
| 1174800049 | John Herman Esser | Internal Medicine | 1050 W Acacia Rd, Milwaukee, WI 53217 | 2011-11-07 |
| 1710298351 | Leann M Harman | Physical Therapist | 5333 N Port Washington Rd Ste B, Glendale, WI 53217 | 2010-06-29 |
| 1306012455 | Emily Marie Gallagher | Speech-Language Pathologist | 6700 N. Port Washington Road, Milwaukee, WI 53217 | 2008-05-07 |
| 1164625455 | Mary Catherine Enderlin | Psychologist | 6110 N Port Washington Road, The Cambridge Group, Glendale, WI 53217 | 2007-06-06 |
| Find all providers in zip 53217 | ||||
| Taxonomy Code | 251E00000X |
| Grouping | Agencies |
| Classification | Home Health |
| A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |
| Notes: Source: CFR42 Chapter IV Part 484, http://www.access.gpo.gov/nara/cfr/waisidx_99/42cfr484_99.html [7/1/2007: definition added, source added] |
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| 1053912436 | Adonai Home Health Care | Home Health | 1010 N Central Ave # 410, Glendale, CA 91202-2937 | 2020-11-03 |
| 1598365793 | Hde Home Health Care Inc | Home Health | 225 E Broadway Ste B103b, Glendale, CA 91205-1008 | 2020-10-27 |
| 1326648585 | Traditional Home Health, Inc | Home Health | 415 E Harvard St Ste 204a, Glendale, CA 91205-1057 | 2020-10-27 |
| 1962002121 | Valley United Home Health Inc | Home Health | 427 W Colorado St Ste 205, Glendale, CA 91204-4811 | 2020-10-27 |
| 1831799204 | Lifepro Home Health Care, Inc. | Home Health | 221 E Glenoaks Blvd # 222b, Glendale, CA 91207-2085 | 2020-10-27 |
| 1205433836 | Guardians Home Health Care | Home Health | 901 S Glendale Ave Ste E, Glendale, CA 91205-5614 | 2020-10-06 |
| 1578170122 | Amg Home Health, Inc | Home Health | 1234 S Glendale Ave Ste A, Glendale, CA 91205-5674 | 2020-09-28 |
| 1912513037 | Wellness Empire | Home Health | 805 E Wilson Ave Unit B, Glendale, CA 91206-4457 | 2020-09-23 |
| 1427664127 | Rainbow Home Health Care | Home Health | 225 E Broadway Ste B105a, Glendale, CA 91205-1008 | 2020-09-17 |
| Find all providers in GLENDALE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.