Healthcare Provider Details

I. General information

NPI: 1699355818
Provider Name (Legal Business Name): FLORIDA UNITED METHODIST CHILDRENS HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 NE CAPTAIN BUIE RD
PINETTA FL
32350-2799
US

IV. Provider business mailing address

51 CHILDRENS WAY
ENTERPRISE FL
32725-8135
US

V. Phone/Fax

Practice location:
  • Phone: 850-929-3000
  • Fax:
Mailing address:
  • Phone: 386-668-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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