Provider Demographics
NPI:1902368988
Name:TWIN LAKES
Entity Type:Organization
Organization Name:TWIN LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERSOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-719-3531
Mailing Address - Street 1:9840 MONTGOMERY ROAD
Mailing Address - Street 2:ATTN: LEC FINANCE
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-719-3516
Mailing Address - Fax:513-719-3528
Practice Address - Street 1:9840 MONTGOMERY ROAD
Practice Address - Street 2:ATTN: LEC FINANCE
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-719-3516
Practice Address - Fax:513-719-3528
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TWIN LAKES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility