Provider Demographics
NPI:1851546725
Name:THE UNITED METHODIST CHILDREN'S HOME
Entity Type:Organization
Organization Name:THE UNITED METHODIST CHILDREN'S HOME
Other - Org Name:METHODIST CHILDREN'S HOME - RTC DACUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-661-0720
Mailing Address - Street 1:1600 ALDERSGATE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6676
Mailing Address - Country:US
Mailing Address - Phone:501-661-0720
Mailing Address - Fax:501-325-7938
Practice Address - Street 1:211 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BONO
Practice Address - State:AR
Practice Address - Zip Code:72416-9578
Practice Address - Country:US
Practice Address - Phone:870-932-8880
Practice Address - Fax:501-325-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171082125Medicaid