Provider Demographics
NPI:1407491277
Name:TWIN DOVES II LLC
Entity Type:Organization
Organization Name:TWIN DOVES II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RICKIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-403-9430
Mailing Address - Street 1:48617 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-9791
Mailing Address - Country:US
Mailing Address - Phone:616-403-9430
Mailing Address - Fax:269-852-5910
Practice Address - Street 1:40739 80TH AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MI
Practice Address - Zip Code:49045-8158
Practice Address - Country:US
Practice Address - Phone:269-852-5910
Practice Address - Fax:269-852-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness