Provider Demographics
NPI:1215064332
Name:TWIN CEDARS YOUTH SERVICES, INC
Entity type:Organization
Organization Name:TWIN CEDARS YOUTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANGSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-298-0050
Mailing Address - Street 1:310 N LEWIS ST
Mailing Address - Street 2:P.O. BOX 1526
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2740
Mailing Address - Country:US
Mailing Address - Phone:706-298-0050
Mailing Address - Fax:706-298-0055
Practice Address - Street 1:1022 E DEPOT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3412
Practice Address - Country:US
Practice Address - Phone:706-884-1717
Practice Address - Fax:706-884-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children