Healthcare Provider Details

I. General information

NPI: 1346680212
Provider Name (Legal Business Name): TWIN OAKS COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 PERKINS LN
EDGEWATER PARK NJ
08010-2207
US

IV. Provider business mailing address

770 WOODLANE RD
WESTAMPTON NJ
08060-3804
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-5928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierPENDING
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: QINDI SHI
Title or Position: CFO
Credential:
Phone: 609-267-5928