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General NPI Number Information
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NPI Number | 1275748923
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Entity Type | Organization
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Legal Business Name | VCMY II CORPORATION
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 04/07/2015
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Provider Practice Location Address
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Address Line | 163 ALPINE DR
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City | SHELBYVILLE
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State | KY
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Zip | 40065-8878
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Country | US
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Telephone | 502-647-3474
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Fax | 502-647-9572
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Provider Business Mailing Address
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Address Line | PO BOX 1294
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City | SHELBYVILLE
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State | KY
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Zip | 40066-1294
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Country | US
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Telephone | 502-647-3474
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Fax | 502-647-9572
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RONNIE JOE MYATT
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Credential |
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Telephone | 502-647-3474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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