# MY SECOND HOME

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Megan's Place, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912352071
- **Authorized official:** MRS. KRISTIN N SMOCK (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (720) 427-1979

## Contact information

- **Practice address:** 6175 W 38TH AVE, WHEAT RIDGE, CO 80033-5146
- **Practice address phone:** (303) 881-4988
- **Practice address fax:** (303) 237-1043
- **Mailing address:** 6175 W 38TH AVE, WHEAT RIDGE, CO 80033-5146
- **Mailing address phone:** (303) 881-4988
- **Mailing address fax:** (303) 237-1043

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385HR2050X | Respite Care Camp | 1655048 | CO | — |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | 1655048 | CO | Yes |
| 385HR2065X | Child Physical Disabilities Respite Care | 1655048 | CO | — |

## Other

- **Enumeration date:** 04/26/2016
- **Last updated:** 04/26/2016