1881669612 NPI number — TWIN LAKES CENTER INC

Table of content: (NPI 1881669612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881669612 NPI number — TWIN LAKES CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWIN LAKES CENTER 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:
UPMC BEHAVIORAL HEALTH SERVICES AT TWIN LAKES
Provider Other Organization Name Type Code:
3
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:
1881669612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 TWIN LAKES ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15501-7727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-443-3639
Provider Business Mailing Address Fax Number:
814-443-2737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 TWIN LAKES ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-7727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-3639
Provider Business Practice Location Address Fax Number:
814-443-2737
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANNON
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, CLINICAL SERVICES
Authorized Official Telephone Number:
814-443-3639

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  561089 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 117037 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 051089 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 561089 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X , with the licence number: 561089 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 327974 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007733110004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100773311 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103501 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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