Provider Demographics
NPI:1891819264
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:PROVIDER RELATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MONARES
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:316-283-1950
Mailing Address - Street 1:900 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2037
Mailing Address - Country:US
Mailing Address - Phone:316-283-1950
Mailing Address - Fax:316-283-9540
Practice Address - Street 1:205 F ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661-1943
Practice Address - Country:US
Practice Address - Phone:785-540-4092
Practice Address - Fax:316-283-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS771-1251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management