Provider Demographics
NPI:1497879985
Name:UNITED METHODIST YOUTHVILLE INC
Entity Type:Organization
Organization Name:UNITED METHODIST YOUTHVILLE INC
Other - Org Name:YOUTHVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOYIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:3164-529-9100
Mailing Address - Street 1:4505 E 47TH ST S
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67210-1651
Mailing Address - Country:US
Mailing Address - Phone:316-529-9100
Mailing Address - Fax:316-529-9351
Practice Address - Street 1:900 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2037
Practice Address - Country:US
Practice Address - Phone:316-283-1950
Practice Address - Fax:316-283-9540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED METHODIST YOUTHVILLE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0015391-001251B00000X
KS771-1251B00000X
KS0015391009323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100007290BMedicaid