Provider Demographics
NPI:1871192427
Name:FLORIDA UNITED METHODIST CHILDRENS HOME, INC.
Entity Type:Organization
Organization Name:FLORIDA UNITED METHODIST CHILDRENS HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF UTILIZATION MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KAYLEE
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LMHC
Authorized Official - Phone:386-668-4774
Mailing Address - Street 1:51 CHILDRENS WAY
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8135
Mailing Address - Country:US
Mailing Address - Phone:386-668-4774
Mailing Address - Fax:
Practice Address - Street 1:9501 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-5721
Practice Address - Country:US
Practice Address - Phone:352-367-8005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA UNITED METHODIST CHILDREN'S HOME INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health