Organization
THE MIRACLE HOUSE, INC
Active
Other names
GWL Residential Services
Organization subpart
No
Provider details
NPI number
Authorized official
JONI EDWINA PUGH (CEO)
(321) 591-4452
Entity
Organization
Contact information
Practice address
19345 LONG ST, MOUNT VERNON, AL 36560-4529
(321) 591-4452
Mailing address
19345 LONG ST, MOUNT VERNON, AL 36560-4529
(321) 591-4452
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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