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General NPI Number Information
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NPI Number | 1043203201
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Entity Type | Organization
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Legal Business Name | TWIN LAKES HOSPICE INC.
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 725 E OHIO ST
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City | CLINTON
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State | MO
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Zip | 64735
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Country | US
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Telephone | 660-890-2014
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Fax | 660-890-2018
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Provider Business Mailing Address
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Address Line | 725 E OHIO ST
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City | CLINTON
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State | MO
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Zip | 64735-2357
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Country | US
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Telephone | 660-890-2014
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Fax | 660-890-2018
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TONY B CURTIS
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Credential |
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Telephone | 660-890-2014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number | 015-8HO
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License Number State | MO
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