1356483572 NPI number — TWIN VALLEY DEVELOPMENTAL SERVICES, INC.

Table of content: (NPI 1356483572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356483572 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:
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:
1356483572
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:
PO BOX 219
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENLEAF
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66943-0219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-747-7903
Provider Business Mailing Address Fax Number:
785-747-2605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 PARK 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:
66943-0219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-747-7903
Provider Business Practice Location Address Fax Number:
785-747-2605
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
COORDINATOR
Authorized Official Telephone Number:
785-747-7903

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 115069 . This is a "OT, PT, AND SLP" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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