Healthcare Provider Details

I. General information

NPI: 1073251948
Provider Name (Legal Business Name): TWIN HEARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2022
Last Update Date: 05/21/2022
Certification Date: 05/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15223 W TAYLOR ST
GOODYEAR AZ
85338-4115
US

IV. Provider business mailing address

15223 W TAYLOR ST
GOODYEAR AZ
85338-4115
US

V. Phone/Fax

Practice location:
  • Phone: 224-595-0112
  • Fax:
Mailing address:
  • Phone: 224-595-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE VANDYCK
Title or Position: MANAGER
Credential:
Phone: 224-595-0110