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General NPI Number Information
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NPI Number | 1053432799
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Entity Type | Organization
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Legal Business Name | METHODIST CHILDREN'S HOME
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 1111 HERRING AVE
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City | WACO
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State | TX
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Zip | 76708-3642
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Country | US
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Telephone | 254-750-2630
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Fax | 254-750-1358
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Provider Business Mailing Address
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Address Line | 1111 HERRING AVE
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City | WACO
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State | TX
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Zip | 76708-3642
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Country | US
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Telephone | 254-750-2630
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Fax | 254-750-1358
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. LON DALE OAKLEY III
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Credential |
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Telephone | 254-750-1201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | C-3052
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License Number State | TX
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