Miracle on 29TH Street

Organization Active NPI Case Manager/Care Coordinator · Phoenix, AZ

NPI 1255835997 · NPPES record last updated Sep 12, 2025

Key facts

NPI
1255835997
Entity type
Organization (NPI type 2)
Primary specialty
Case Manager/Care Coordinator 171M00000X
License
AL10509H (AZ)
Legal business name
MIRACLE ON 29TH STREET
Practice address
18210 N 29TH St
Phoenix, AZ 85032-1103
Phone
(480) 302-1101
NPI assigned
Mar 19, 2018
Organization subpart
No

Authorized official

Name
Mr. Troy Berkley
Title
Owner
Phone
(480) 302-1101

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator
Group: 193200000X MULTI-SPECIALTY GROUP
171M00000X AL10509H AZ Yes

Addresses

Primary practice location

18210 N 29TH St
Phoenix, AZ 85032-1103

Mailing address

18210 N 29TH St
Phoenix, AZ 85032-1103
Phone (480) 302-1101

Other names

  • Koala-D Meds Doing business as

Other providers in Phoenix, AZ

All providers in Phoenix, AZ · Case Manager/Care Coordinator in Arizona

Sources for this page

Verify at the official NPI Registry.