Provider Demographics
NPI:1295820835
Name:TWIN TOWN CORPORATION
Entity Type:Organization
Organization Name:TWIN TOWN CORPORATION
Other - Org Name:TWIN TOWN TREATMENT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LISONBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-629-9669
Mailing Address - Street 1:4281 KATELLA AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6500
Mailing Address - Country:US
Mailing Address - Phone:562-594-8844
Mailing Address - Fax:562-493-1280
Practice Address - Street 1:4281 KATELLA AVE STE 117
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3590
Practice Address - Country:US
Practice Address - Phone:562-596-0050
Practice Address - Fax:562-596-0058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TWIN TOWN CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300128 & 190290261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder