Basic Information
| Provider Information | |||||||||
| NPI: | 1306824776 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TWIN RIVERS, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | RIVER HILLS VILLAGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 20 VILLAGE CIR | ||||||||
| Address2: | |||||||||
| City: | KEOKUK | ||||||||
| State: | IA | ||||||||
| PostalCode: | 526322040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3195245772 | ||||||||
| FaxNumber: | 3195243001 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 VILLAGE CIR | ||||||||
| Address2: | |||||||||
| City: | KEOKUK | ||||||||
| State: | IA | ||||||||
| PostalCode: | 526322040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3195245772 | ||||||||
| FaxNumber: | 3195243001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STEINKRUGER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | MCCALL | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3195245772 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN, NHA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | IA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0805283 | 05 | IA | MEDICAID | 560878 | 01 | IA | STATE LICENSURE NUMBER | OTHER |