Basic Information
| Provider Information | |||||||||
| NPI: | 1174892046 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TWIN OAKS COMMUNITY SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 WOODLANE RD | ||||||||
| Address2: | |||||||||
| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080603804 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 820 UNION MILL RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080549561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092675928 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2011 | ||||||||
| LastUpdateDate: | 12/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | SHI | ||||||||
| AuthorizedOfficialFirstName: | QINDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT/CFO | ||||||||
| AuthorizedOfficialTelephone: | 6092675928 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 0087939 | 05 | NJ | MEDICAID |