Healthcare Provider Details

I. General information

NPI: 1972607695
Provider Name (Legal Business Name): UNITED METHODIST BEHAVIORAL HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 MAIN ST
VILONIA AR
72173-9524
US

IV. Provider business mailing address

1600 ALDERSGATE RD SUITE 200
LITTLE ROCK AR
72205-6676
US

V. Phone/Fax

Practice location:
  • Phone: 501-772-9278
  • Fax: 501-421-2350
Mailing address:
  • Phone: 501-661-0720
  • Fax: 501-325-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LESLEY DON COLE
Title or Position: CFO
Credential:
Phone: 501-661-0720