Basic Information
Provider Information | |||||||||
NPI: | 1497992390 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LOUISIANA UNITED METHODIST CHILDREN & FAMILY SERVICES, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | METHODIST CHILDREN'S HOME OF SOUTHEAST LOUISIANA | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 904 DEVILLE LANE | ||||||||
Address2: |   | ||||||||
City: | RUSTON | ||||||||
State: | LA | ||||||||
PostalCode: | 71270 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3182555020 | ||||||||
FaxNumber: | 3182556623 | ||||||||
Practice Location | |||||||||
Address1: | 49242 HWY 445 | ||||||||
Address2: |   | ||||||||
City: | LORANGER | ||||||||
State: | LA | ||||||||
PostalCode: | 70446 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9856069900 | ||||||||
FaxNumber: | 9856069970 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/14/2009 | ||||||||
LastUpdateDate: | 06/22/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WHEAT | ||||||||
AuthorizedOfficialFirstName: | RICK | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 3182555020 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/22/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | 258-PRTF | LA | Y |   | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |   |
No ID Information.