Provider Demographics
NPI: | 1124459433 |
---|---|
Name: | TWIN OAKS COMMUNITY SERVICES, INC |
Entity type: | Organization |
Organization Name: | TWIN OAKS COMMUNITY SERVICES, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | QINDI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 609-267-5928 |
Mailing Address - Street 1: | 770 WOODLANE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | WESTAMPTON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08060-3804 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 550 ROUTE 22 |
Practice Address - Street 2: | |
Practice Address - City: | BRIDGEWATER |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08807-2405 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-267-5928 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-12-12 |
Last Update Date: | 2013-12-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | PENDING | Medicaid |