Healthcare Provider Details

I. General information

NPI: 1487820445
Provider Name (Legal Business Name): VENTURE HOME AGAIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 F M STAFFORD AVE
PAINTSVILLE KY
41240-1230
US

IV. Provider business mailing address

610 F M STAFFORD AVE
PAINTSVILLE KY
41240
US

V. Phone/Fax

Practice location:
  • Phone: 606-789-5576
  • Fax: 606-789-8612
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. WILLIAM SHACKLEFORD
Title or Position: CHIEF OPERATIONG OFFICER
Credential:
Phone: 606-789-5576