1306824776 NPI number — TWIN RIVERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306824776 NPI number — TWIN RIVERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWIN RIVERS, 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:
6
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:
1306824776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 VILLAGE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEOKUK
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52632-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-524-5772
Provider Business Mailing Address Fax Number:
319-524-3001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 VILLAGE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEOKUK
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52632-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-524-5772
Provider Business Practice Location Address Fax Number:
319-524-3001
Provider Enumeration Date:
01/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEINKRUGER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
MCCALL
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
319-524-5772

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0805283 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 560878 . This is a "STATE LICENSURE NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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