Organization
MRACLES RESIDENTIAL CARE LLC-MILLER HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEDREE RENEE CARLISLE (DIRECTOR)
(816) 521-8896
Entity
Organization
Contact information
Practice address
1124 E 79TH ST, KANSAS CITY, MO 64131-1967
(816) 437-7027
Mailing address
1124 E 79TH ST, KANSAS CITY, MO 64131-1967
(816) 437-7027
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
—
856273107
—
MO
Enumeration date
03/21/2007
Last updated
03/25/2014
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