Provider Demographics
NPI:1881669612
Name:TWIN LAKES CENTER INC
Entity Type:Organization
Organization Name:TWIN LAKES CENTER INC
Other - Org Name:UPMC BEHAVIORAL HEALTH SERVICES AT TWIN LAKES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-443-3639
Mailing Address - Street 1:224 TWIN LAKES ROAD
Mailing Address - Street 2:
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:814-443-2737
Practice Address - Street 1:224 TWIN LAKES ROAD
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:814-443-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA561089251S00000X, 261QR0405X, 324500000X
PA117037261Q00000X
PA051089261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA327974OtherVALUE OPTIONS
PA1007733110004Medicaid
PA100773311Medicaid
PA103501OtherUPMC