Provider Demographics
NPI:1568123412
Name:MIRACLE HOUSES INC
Entity type:Organization
Organization Name:MIRACLE HOUSES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-535-4447
Mailing Address - Street 1:9307 MONROE RD STE K
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1485
Mailing Address - Country:US
Mailing Address - Phone:704-315-3895
Mailing Address - Fax:704-535-4476
Practice Address - Street 1:1700 INDUSTRIAL CENTER CIR STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4417
Practice Address - Country:US
Practice Address - Phone:704-535-4447
Practice Address - Fax:704-535-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health