MEDICARE: TWIN OAK EXTENDED CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1467122648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN OAK EXTENDED CARE INC

Provider Business Mailing Address
First Line	:	27024 NORFOLK ST
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-2306
Country	:	US
Telephone Number	:	734-620-8067
Fax Number	:

Provider Business Practice Location Address
First Line	:	27024 NORFOLK ST
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-2306
Country	:	US
Telephone Number	:	734-620-8067
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ANH HUYNH
Credential	:
Telephone Number	:	734-620-8067

Provider Enumeration Date	:	09/17/2021
Last Update Date	:	09/17/2021

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