Provider Demographics
NPI:1235458472
Name:TWIN LAKES CENTER, INC.
Entity Type:Organization
Organization Name:TWIN LAKES CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-443-3639
Mailing Address - Street 1:224 TWIN LAKE RD
Mailing Address - Street 2:PO BOX 909
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-7727
Mailing Address - Country:US
Mailing Address - Phone:814-443-3639
Mailing Address - Fax:
Practice Address - Street 1:224 TWIN LAKE RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-7727
Practice Address - Country:US
Practice Address - Phone:814-443-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA561089324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100773311Medicaid