Provider Demographics
NPI:1194933788
Name:BURLINGTON UNITED METHODIST FAMILY SERVICES INC
Entity type:Organization
Organization Name:BURLINGTON UNITED METHODIST FAMILY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-289-6010
Mailing Address - Street 1:RR 3 BOX 3122
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-9413
Mailing Address - Country:US
Mailing Address - Phone:304-289-6010
Mailing Address - Fax:304-289-3903
Practice Address - Street 1:RR 3 BOX 3122
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-9413
Practice Address - Country:US
Practice Address - Phone:304-289-6010
Practice Address - Fax:304-289-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV08GRR040322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020325Medicaid