Healthcare Provider Details

I. General information

NPI: 1346314796
Provider Name (Legal Business Name): THE METHODIST HOME FOR CHILDREN, IN.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2006
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 N HILLS DR
RALEIGH NC
27612-5909
US

IV. Provider business mailing address

1041 WASHINGTON ST
RALEIGH NC
27605-1259
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-8389
  • Fax: 919-782-8387
Mailing address:
  • Phone: 919-754-3638
  • Fax: 919-755-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL092518
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN R FRANKFORT-WINNINGHAM
Title or Position: DIRECTOR OF QUALITY IMPROVEMENT
Credential:
Phone: 919-754-3638