Basic Information
Provider Information
NPI: 1255579157
EntityType: 2
ReplacementNPI:  
OrganizationName: UNITED METHODIST BEHAVIORAL HEALTH SYSTEMS, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: AR SHERIFF'S RANCH - AMITY
OtherOrganizationType: 5
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1600 ALDERSGATE RD
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722056614
CountryCode: US
TelephoneNumber: 5016610720
FaxNumber: 5013257938
Practice Location
Address1: 35 YOUTH RANCH RD
Address2:  
City: AMITY
State: AR
PostalCode: 719219602
CountryCode: US
TelephoneNumber: 5016610720
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/30/2009
LastUpdateDate: 01/30/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ALTOM
AuthorizedOfficialFirstName: ANDY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 5016610720
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


Home