Organization
VCMY II CORPORATION
Active
Other names
MyHomeplace
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONNIE JOE MYATT (EXECUTIVE DIRECTOR)
(502) 647-3474
Entity
Organization
Contact information
Practice address
163 ALPINE DR, SHELBYVILLE, KY 40065-8878
(502) 647-3474
(502) 647-9572
Mailing address
PO BOX 1294, SHELBYVILLE, KY 40066-1294
(502) 647-3474
(502) 647-9572
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33000688
—
KY
Enumeration date
05/14/2007
Last updated
04/07/2015
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