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MIRACLE ON 29TH STREET NPI 1255835997


NPI Information

NPI: 1255835997
Provider Name: MIRACLE ON 29TH STREET

Doing Business As: KOALA-D MEDS

Classification: Case Manager/Care Coordinator - 171M00000X
Entity Type: Organization
Address:
18210 N 29TH ST
PHOENIX, AZ
ZIP 85032
Phone: (480) 302-1101
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MIRACLE ON 29TH STREET is a case manager care coordinator in Phoenix, AZ. The provider is a person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee's progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. MIRACLE ON 29TH STREET NPI is 1255835997. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Koala-d Meds.

The provider's business location address is:

18210 N 29TH ST
PHOENIX, AZ
ZIP 85032-103
Phone: (480) 302-1101

The provider's authorized official is Troy Berkley .
The authorized official title is Owner and has the following contact phone number (480) 302-1101.

The enumeration date for this NPI number is 3/19/2018 and was last updated on 6/12/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1171M00000XCase Manager/Care CoordinatorAL10509HARIZONAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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