=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407282247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TWIN TOWN CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2013
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 705 WEST LA VETA STE. 208
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-532-9295
-----------------------------------------------------
Fax | 562-493-1280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4281 KATELLA AVE STE 211
-----------------------------------------------------
City | LOS ALAMITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90720-6500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-532-9295
-----------------------------------------------------
Fax | 714-532-9291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ PRESIDENT
-----------------------------------------------------
Name | MR. DAVID PAUL LISONBEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-629-9669
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 300128CP
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------