Provider Demographics
NPI:1376751958
Name:BURLINGTON UNITED METHODIST FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:BURLINGTON UNITED METHODIST FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-289-6010
Mailing Address - Street 1:RR 3 BOX 3122
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-9413
Mailing Address - Country:US
Mailing Address - Phone:304-788-2342
Mailing Address - Fax:304-788-2409
Practice Address - Street 1:RR 3 BOX 3122
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-9413
Practice Address - Country:US
Practice Address - Phone:304-788-2342
Practice Address - Fax:304-788-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV08GRR011322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0187018000Medicaid