Healthcare Provider Details

I. General information

NPI: 1225006059
Provider Name (Legal Business Name): FLORIDA UNITED METHODIST CHILDREN'S HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 CHILDREN'S WAY
ENTERPRISE FL
32725
US

IV. Provider business mailing address

51 CHILDREN'S WAY
ENTERPRISE FL
32725
US

V. Phone/Fax

Practice location:
  • Phone: 386-668-4774
  • Fax: 386-668-4486
Mailing address:
  • Phone: 386-668-4774
  • Fax: 386-668-4486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberX11030599
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberX11030500
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAYLEE VANCE
Title or Position: DIRECTOR OF UTILIZATION MANAGEMENT
Credential:
Phone: 386-668-4774