Provider Demographics
NPI:1619146115
Name:UNITED METHODIST CHILDREN'S HOME OF SOUTHERN ILLINOIS INC.
Entity Type:Organization
Organization Name:UNITED METHODIST CHILDREN'S HOME OF SOUTHERN ILLINOIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLETE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WINKELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:618-242-1070
Mailing Address - Street 1:2023 RICHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2884
Mailing Address - Country:US
Mailing Address - Phone:618-242-1070
Mailing Address - Fax:618-242-9381
Practice Address - Street 1:2023 RICHVIEW RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2884
Practice Address - Country:US
Practice Address - Phone:618-242-1070
Practice Address - Fax:618-242-9381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021068-11322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5000-IPI-09Medicaid