1356556799 NPI number — TWIN VALLEY DEVELOPMENTAL SERVICES,INC.

Table of content: (NPI 1356556799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356556799 NPI number — TWIN VALLEY DEVELOPMENTAL SERVICES,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWIN VALLEY DEVELOPMENTAL SERVICES,INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356556799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 42
Provider Second Line Business Mailing Address:
413 COMMERCIAL ST.
Provider Business Mailing Address City Name:
GREENLEAF
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-747-2251
Provider Business Mailing Address Fax Number:
785-747-2254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
413 COMMERCIAL ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENLEAF
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-747-2251
Provider Business Practice Location Address Fax Number:
785-747-2254
Provider Enumeration Date:
05/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
EDGAR
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
785-747-2251

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100008280A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100027240A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".