Organization
MIRACLE HOUSES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATSY Y CAMP (EXECUTIVE DIRECTOR)
(704) 369-1445
Entity
Organization
Contact information
Practice address
2627 PROVIDENCE RD, CHARLOTTE, NC 28211-2238
(980) 938-8304
Mailing address
2627 PROVIDENCE RD, CHARLOTTE, NC 28211-2238
(980) 938-8304
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111204
—
NC
Enumeration date
04/22/2016
Last updated
04/22/2016
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