Provider Demographics
NPI:1073251948
Name:TWIN HEARTS LLC
Entity Type:Organization
Organization Name:TWIN HEARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDYCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-595-0110
Mailing Address - Street 1:15223 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4115
Mailing Address - Country:US
Mailing Address - Phone:224-595-0112
Mailing Address - Fax:
Practice Address - Street 1:15223 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-4115
Practice Address - Country:US
Practice Address - Phone:224-595-0112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility