Provider Demographics
NPI:1760597215
Name:UNITED METHODIST CHILDREN'S HOME
Entity Type:Organization
Organization Name:UNITED METHODIST CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W,
Authorized Official - Last Name:LISENBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-875-7283
Mailing Address - Street 1:PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-0830
Mailing Address - Country:US
Mailing Address - Phone:334-875-7283
Mailing Address - Fax:334-875-5161
Practice Address - Street 1:1712 BROAD ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4102
Practice Address - Country:US
Practice Address - Phone:334-875-7283
Practice Address - Fax:334-875-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children