Miracle Mile Medical Center

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

MIRACLE MILE MEDICAL CENTER

Doing business as

Miracle Mile Recovery

Practice address

15910 Ventura Blvd Ste 1719
Encino, CA 91436-2838

Phone

(310) 905-9682

NPI assigned

Jan 26, 2024

Last updated

Sep 19, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jordan Jackelini

Title

President

Phone

(310) 905-9682

Specialties & licenses 2

Addresses

Other names 1

• Miracle Mile Recovery Doing business as

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1174385934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15910 VENTURA BLVD STE 1719",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362838",
            "telephone_number": "310-905-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15910 VENTURA BLVD STE 1719",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362838",
            "telephone_number": "310-905-9682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE MILE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-26",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "JACKELINI",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-905-9682",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "BestNotes",
            "affiliation": "N",
            "endpointDescription": "EMR System",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "15910 Ventura Blvd Ste 1719",
            "city": "Encino",
            "state": "CA",
            "country_code": "US",
            "postal_code": "914362838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Miracle Mile Recovery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Miracle Mile Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Minehart Medical Corporation (Encino Surgical Medical Center)
• Robert Louis Ming, M.D.
• Danielle Kristine Minner
• Maxine Mintzer
• Miracle Board and Care&Asssisted Living
• Venus Mirbod, PSY.D.
• Ali Mirfakhrai, D.C.
• Roberta E. Mirisch, L.C.S.W.
• Haris Mirza
• Misra Medical Corp

• Substance Abuse Rehabilitation Facility in Encino, CA
• Providers in Encino, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.