Provider Demographics
NPI:1912316910
Name:MIRACLE HOUSES, INC.
Entity Type:Organization
Organization Name:MIRACLE HOUSES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-315-3895
Mailing Address - Street 1:7508 E INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9473
Mailing Address - Country:US
Mailing Address - Phone:704-535-4447
Mailing Address - Fax:704-535-4476
Practice Address - Street 1:1750 HIGHWAY 160 W
Practice Address - Street 2:SUITE 101-319
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8009
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:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111204251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health