Provider Demographics
NPI:1124705058
Name:TWIN CITIES IMPACT
Entity type:Organization
Organization Name:TWIN CITIES IMPACT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRILA
Authorized Official - Middle Name:NAOMIE
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:651-329-0733
Mailing Address - Street 1:11208 HANSON BLVD NW UNIT 215
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3731
Mailing Address - Country:US
Mailing Address - Phone:651-329-0733
Mailing Address - Fax:
Practice Address - Street 1:11208 HANSON BLVD NW UNIT 215
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3731
Practice Address - Country:US
Practice Address - Phone:651-329-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services