Provider Demographics
NPI:1861090706
Name:MIRACLE HOUSES, INC.
Entity type:Organization
Organization Name:MIRACLE HOUSES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
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 1:4410 E INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7404
Mailing Address - Country:US
Mailing Address - Phone:704-535-4447
Mailing Address - Fax:704-535-4476
Practice Address - Street 1:320 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROUTMAN
Practice Address - State:NC
Practice Address - Zip Code:28166-9644
Practice Address - Country:US
Practice Address - Phone:704-535-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health