Organization
MRACLES RESIDENTIAL CARE LLC-FALL HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEDREE RENEE CARLISLE (ADMINISTRATOR)
(816) 521-8896
Entity
Organization
Contact information
Practice address
1130 E 75TH TER, KANSAS CITY, MO 64131-1901
(816) 521-8896
(816) 521-8896
Mailing address
1130 E 75TH TER, KANSAS CITY, MO 64131-1901
(816) 521-8896
(816) 437-7027
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/02/2008
Last updated
10/16/2013
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