Healthcare Provider Details

I. General information

NPI: 1679697445
Provider Name (Legal Business Name): TWIN RIVERS DEVELOPMENTAL SUPPORTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22179 D STREET STROTHER FIELD INDUSTRIAL PARK
ARKANSAS CITY KS
67005-0133
US

IV. Provider business mailing address

PO BOX 133
ARKANSAS CITY KS
67005-0133
US

V. Phone/Fax

Practice location:
  • Phone: 620-442-3575
  • Fax: 620-442-3733
Mailing address:
  • Phone: 620-442-3575
  • Fax: 620-442-3733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN F BOYLE
Title or Position: CFO
Credential:
Phone: 620-442-3575