Healthcare Provider Details

I. General information

NPI: 1649221011
Provider Name (Legal Business Name): TWIN OAKS JUVENILE DEVELOPMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11939 NW STATE ROAD 20
BRISTOL FL
32321-3416
US

IV. Provider business mailing address

PO BOX 68
BRISTOL FL
32321-0068
US

V. Phone/Fax

Practice location:
  • Phone: 850-643-1090
  • Fax: 850-643-1091
Mailing address:
  • Phone: 850-643-1090
  • Fax: 850-643-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD B READ
Title or Position: CEO
Credential:
Phone: 850-643-1090