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General NPI Number Information
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NPI Number | 1831332691
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Entity Type | Organization
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Legal Business Name | BOUNDLESS MIRACLES, LLC
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 820 S POST RD
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City | SHELBY
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State | NC
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Zip | 28152-6931
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Country | US
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Telephone | 704-406-9813
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Fax | 704-406-9857
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Provider Business Mailing Address
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Address Line | 820 S POST RD STE A
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City | SHELBY
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State | NC
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Zip | 28152-6931
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Country | US
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Telephone | 704-406-9813
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Fax | 704-406-9857
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Authorized Official
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Title or Position | OWNER / CEO
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Name | MR. RONALD KEITH CHURCH
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Credential |
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Telephone | 704-692-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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