MEDICARE: TWIN LAKE ASSISTED LIVING

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	310400000X	Assisted Living Facility	AS610387285	MI

General Provider Information

NPI Number	:	1679087894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN LAKE ASSISTED LIVING

Provider Business Mailing Address
First Line	:	3790 E. MCMILLAN RD.
Second Line	:
City	:	TWIN LAKE
State	:	MI
Zip	:	49457
Country	:	US
Telephone Number	:	231-788-8609
Fax Number	:	231-457-4965

Provider Business Practice Location Address
First Line	:	3790 MCMILLAN RD
Second Line	:
City	:	TWIN LAKE
State	:	MI
Zip	:	49457-9277
Country	:	US
Telephone Number	:	231-788-8609
Fax Number	:	231-457-4965

Authorized Official
Title or Position	:	OWNER
Name	:	LYNN VANBLARGAN
Credential	:
Telephone Number	:	231-788-8609

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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Directions to “TWIN LAKE ASSISTED LIVING ” Practice Location

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