Healthcare Provider Details

I. General information

NPI: 1003174038
Provider Name (Legal Business Name): RELIANT TWIN OAKS HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 HORSESHOE PIKE
CAMPBELLTOWN PA
17010-0137
US

IV. Provider business mailing address

3601 ISLAND AVE
PHILADELPHIA PA
19153-3228
US

V. Phone/Fax

Practice location:
  • Phone: 717-838-2231
  • Fax:
Mailing address:
  • Phone: 215-558-3700
  • Fax: 215-558-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MARC MYZAL
Title or Position: COO
Credential:
Phone: 215-558-3700