Provider Demographics
NPI:1225006059
Name:FLORIDA UNITED METHODIST CHILDREN'S HOME INC.
Entity Type:Organization
Organization Name:FLORIDA UNITED METHODIST CHILDREN'S HOME INC.
Other - Org Name:FUMCH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF UTILIZATION MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KAYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-668-4774
Mailing Address - Street 1:51 CHILDREN'S WAY
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:FL
Mailing Address - Zip Code:32725
Mailing Address - Country:US
Mailing Address - Phone:386-668-4774
Mailing Address - Fax:386-668-4486
Practice Address - Street 1:51 CHILDREN'S WAY
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:386-668-4774
Practice Address - Fax:386-668-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
FLX11030500253J00000X
FLX11030599322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070513600Medicaid
FLX11030500OtherDEPT OF CHILDREN FAMILIES
FLX11030599OtherDEPT OF CHILDREN FAMILIES