Healthcare Provider Details

I. General information

NPI: 1790694107
Provider Name (Legal Business Name): MIRACLE HOUSES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 ELDORADO AVE
CHARLOTTE NC
28262-3238
US

IV. Provider business mailing address

9307 MONROE RD STE K
CHARLOTTE NC
28270-1485
US

V. Phone/Fax

Practice location:
  • Phone: 704-535-4447
  • Fax: 704-246-6439
Mailing address:
  • Phone: 704-535-4447
  • Fax: 704-246-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PATSY Y. CAMP
Title or Position: EXECUTIVE DIRECTOR
Credential: DOCTORAL
Phone: 704-535-4447