Provider Demographics
NPI:1528813359
Name:MIRACLE HOUSES, INC.
Entity type:Organization
Organization Name:MIRACLE HOUSES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-315-3895
Mailing Address - Street 1:3205 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-1827
Mailing Address - Country:US
Mailing Address - Phone:704-315-3895
Mailing Address - Fax:
Practice Address - Street 1:3205 CHERRY ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-1827
Practice Address - Country:US
Practice Address - Phone:704-315-3895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRACLE HOUSES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health