=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285884411
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TWINS SERVICES AND TRAINING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2008
-----------------------------------------------------
Last Update Date | 09/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22910 TEIL GLEN RD
-----------------------------------------------------
City | WILDOMAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92595-8099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-378-8393
-----------------------------------------------------
Fax | 888-497-4968
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22910 TEIL GLEN RD
-----------------------------------------------------
City | WILDOMAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92595-8099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-378-8393
-----------------------------------------------------
Fax | 888-497-4968
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ OWNER
-----------------------------------------------------
Name | MRS. SHAREE JEAN WILLIAMS
-----------------------------------------------------
Credential | LVN
-----------------------------------------------------
Telephone | 951-378-8393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3140N1450X
-----------------------------------------------------
Taxonomy Name | Pediatric Skilled Nursing Facility
-----------------------------------------------------
License Number | 334819513
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------