Provider Demographics
NPI:1457836736
Name:MIRACLE HOUSES, INC.
Entity Type:Organization
Organization Name:MIRACLE HOUSES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COLENN
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-535-4447
Mailing Address - Street 1:7508 E. INDEPENDENCE BLVD.
Mailing Address - Street 2:STE. 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9409
Mailing Address - Country:US
Mailing Address - Phone:704-535-4447
Mailing Address - Fax:704-535-4476
Practice Address - Street 1:7827 KERRY BROOK CIRCLE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214
Practice Address - Country:US
Practice Address - Phone:704-535-4447
Practice Address - Fax:704-535-4476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRACLE HOUSES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness