Provider Demographics
NPI:1679087894
Name:TWIN LAKE ASSISTED LIVING
Entity Type:Organization
Organization Name:TWIN LAKE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANBLARGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-788-8609
Mailing Address - Street 1:3790 E. MCMILLAN RD.
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457
Mailing Address - Country:US
Mailing Address - Phone:231-788-8609
Mailing Address - Fax:231-457-4965
Practice Address - Street 1:3790 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:TWIN LAKE
Practice Address - State:MI
Practice Address - Zip Code:49457-9277
Practice Address - Country:US
Practice Address - Phone:231-788-8609
Practice Address - Fax:231-457-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS610387285310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility