Provider Demographics
NPI:1326177452
Name:TWIN CITY RESIDENTIAL CARE, INC.
Entity Type:Organization
Organization Name:TWIN CITY RESIDENTIAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:636-937-3851
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-0092
Mailing Address - Country:US
Mailing Address - Phone:636-937-3851
Mailing Address - Fax:636-933-4774
Practice Address - Street 1:1 HOLDING LN
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-1122
Practice Address - Country:US
Practice Address - Phone:636-937-3851
Practice Address - Fax:636-933-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO416-8406320600000X
MO031862320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities