MEDICARE: METHODIST CHILDREN'S HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	C-3052	TX

General Provider Information

NPI Number	:	1053432799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST CHILDREN'S HOME

Provider Business Mailing Address
First Line	:	1111 HERRING AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-3642
Country	:	US
Telephone Number	:	254-753-6061
Fax Number	:	254-750-1358

Provider Business Practice Location Address
First Line	:	1111 HERRING AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-3642
Country	:	US
Telephone Number	:	254-753-6061
Fax Number	:	254-750-1358

Authorized Official
Title or Position	:	SR. VICE PRESIDENT
Name	:	MR. JOE W. BAILEY JR.
Credential	:
Telephone Number	:	254-750-1205

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/16/2008

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Directions to “METHODIST CHILDREN'S HOME ” Practice Location

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