Provider Demographics
NPI:1285870691
Name:TWIN OAKS
Entity type:Organization
Organization Name:TWIN OAKS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:912-537-7758
Mailing Address - Street 1:218 BUCKHORN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-9759
Mailing Address - Country:US
Mailing Address - Phone:912-537-7787
Mailing Address - Fax:912-537-0825
Practice Address - Street 1:582 MEL BLOUNT RD
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-9714
Practice Address - Country:US
Practice Address - Phone:912-537-7758
Practice Address - Fax:912-537-0825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMP WANNA BE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA138-01-010-9302F00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No302F00000XManaged Care OrganizationsExclusive Provider Organization