Healthcare Provider Details

I. General information

NPI: 1689050916
Provider Name (Legal Business Name): VICTORIA'S DREAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8345 BLOOMFIELD RD
BLOOMFIELD KY
40008-7000
US

IV. Provider business mailing address

8345 BLOOMFIELD RD
BLOOMFIELD KY
40008-7000
US

V. Phone/Fax

Practice location:
  • Phone: 502-507-2925
  • Fax:
Mailing address:
  • Phone: 502-507-2925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JON MICHAEL MCMURPHY
Title or Position: CHIEF OPERATION OFFICER
Credential: RN
Phone: 502-507-2925