Provider Demographics
NPI:1053432799
Name:METHODIST CHILDREN'S HOME
Entity type:Organization
Organization Name:METHODIST CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:254-750-1205
Mailing Address - Street 1:1111 HERRING AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3642
Mailing Address - Country:US
Mailing Address - Phone:254-753-6061
Mailing Address - Fax:254-750-1358
Practice Address - Street 1:1111 HERRING AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3642
Practice Address - Country:US
Practice Address - Phone:254-753-6061
Practice Address - Fax:254-750-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC-3052322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children