Provider Demographics
NPI:1164813168
Name:TWIN OAKS LIVING COMMUNITIES
Entity Type:Organization
Organization Name:TWIN OAKS LIVING COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-550-1084
Mailing Address - Street 1:111 PINE ST W
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-3114
Mailing Address - Country:US
Mailing Address - Phone:770-550-1084
Mailing Address - Fax:912-537-0825
Practice Address - Street 1:887 TH TIPPETT RD
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-9773
Practice Address - Country:US
Practice Address - Phone:770-550-1084
Practice Address - Fax:912-537-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health