Organization
MIRACLE HOUSES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. XAVIER YOUNG (DIVISION DIRECTOR)
(704) 315-3895
Entity
Organization
Contact information
Practice address
1750 HIGHWAY 160 W, SUITE 101-319, FORT MILL, SC 29708-8009
(704) 535-4447
(704) 535-4476
Mailing address
7508 E INDEPENDENCE BLVD, SUITE 119, CHARLOTTE, NC 28227-9473
(704) 535-4447
(704) 535-4476
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
111204
NC
Other
Enumeration date
08/05/2014
Last updated
08/05/2014
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