MEDICARE: TWIN OAKS ESTATE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	034141	MO

General Provider Information

NPI Number	:	1336311729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN OAKS ESTATE, INC

Provider Business Mailing Address
First Line	:	707 EMGE RD
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-2118
Country	:	US
Telephone Number	:	636-240-6152
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 EMGE RD
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-2118
Country	:	US
Telephone Number	:	636-240-6152
Fax Number	:

Authorized Official
Title or Position	:	PAYROLL MANAGER / OWNER
Name	:	KIM BAUER
Credential	:
Telephone Number	:	636-240-6152

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	03/26/2008

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