Healthcare Provider Details

I. General information

NPI: 1033567482
Provider Name (Legal Business Name): TWIN OAKS ADC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N MADISON ST
MALDEN MO
63863-1939
US

IV. Provider business mailing address

113 N MADISON ST
MALDEN MO
63863-1939
US

V. Phone/Fax

Practice location:
  • Phone: 573-276-8916
  • Fax: 573-276-2263
Mailing address:
  • Phone: 573-276-8916
  • Fax: 573-276-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. JOHN WELCH
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-276-8916