Provider Demographics
NPI:1053710814
Name:MIRACLE GROUP INC
Entity type:Organization
Organization Name:MIRACLE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, CCDP
Authorized Official - Phone:717-232-6170
Mailing Address - Street 1:1800 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17103-1551
Mailing Address - Country:US
Mailing Address - Phone:717-232-6170
Mailing Address - Fax:717-307-3535
Practice Address - Street 1:1800 STATE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17103-1551
Practice Address - Country:US
Practice Address - Phone:717-232-6170
Practice Address - Fax:717-307-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health