MEDICARE: TWIN RIVER COMMUNITY LIVING FACILITY

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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881150969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN RIVER COMMUNITY LIVING FACILITY

Provider Business Mailing Address
First Line	:	201 DODD ST
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-4757
Country	:	US
Telephone Number	:	870-425-4515
Fax Number	:	870-425-3933

Provider Business Practice Location Address
First Line	:	201 DODD ST
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-4757
Country	:	US
Telephone Number	:	870-425-4515
Fax Number	:	870-425-3933

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. OLIVIA MCDANIEL
Credential	:
Telephone Number	:	870-425-4515

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	02/14/2019

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