# MRACLES RESIDENTIAL CARE LLC-FALL HOUSE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861664591
- **Authorized official:** MS. DEDREE RENEE CARLISLE (ADMINISTRATOR)
- **Authorized official phone:** (816) 521-8896

## Contact information

- **Practice address:** 1130 E 75TH TER, KANSAS CITY, MO 64131-1901
- **Practice address phone:** (816) 521-8896
- **Practice address fax:** (816) 521-8896
- **Mailing address:** 1130 E 75TH TER, KANSAS CITY, MO 64131-1901
- **Mailing address phone:** (816) 521-8896
- **Mailing address fax:** (816) 437-7027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 04/02/2008
- **Last updated:** 10/16/2013