Healthcare Provider Details

I. General information

NPI: 1356556799
Provider Name (Legal Business Name): TWIN VALLEY DEVELOPMENTAL SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 COMMERCIAL ST.
GREENLEAF KS
66943
US

IV. Provider business mailing address

PO BOX 42 413 COMMERCIAL ST.
GREENLEAF KS
66943
US

V. Phone/Fax

Practice location:
  • Phone: 785-747-2251
  • Fax: 785-747-2254
Mailing address:
  • Phone: 785-747-2251
  • Fax: 785-747-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateKS
# 6
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100008280A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 2
Identifier100027240A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name: MR. EDGAR C. HENRY
Title or Position: CEO
Credential:
Phone: 785-747-2251