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General NPI Number Information
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NPI Number | 1295909877
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Entity Type | Organization
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Legal Business Name | MIRACLE HOUSE, INC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 1997 E MAIN ST
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City | VENTURA
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State | CA
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Zip | 93001-3406
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Country | US
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Telephone | 805-648-7857
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Fax | 805-648-7540
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Provider Business Mailing Address
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Address Line | 1997 E MAIN ST
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City | VENTURA
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State | CA
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Zip | 93001-3406
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Country | US
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Telephone | 805-648-7857
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Fax | 805-648-7540
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. NORMAN FRANK PATTON
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Credential |
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Telephone | 805-648-7857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 560007AN
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 56000CN
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 072703 1
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License Number State | CA
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