Provider Demographics
NPI:1861664591
Name:MRACLES RESIDENTIAL CARE LLC-FALL HOUSE
Entity Type:Organization
Organization Name:MRACLES RESIDENTIAL CARE LLC-FALL HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEDREE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-521-8896
Mailing Address - Street 1:1130 E 75TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1901
Mailing Address - Country:US
Mailing Address - Phone:816-521-8896
Mailing Address - Fax:816-437-7027
Practice Address - Street 1:1130 E 75TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1901
Practice Address - Country:US
Practice Address - Phone:816-521-8896
Practice Address - Fax:816-521-8896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities