Provider Demographics
NPI:1942363361
Name:TWIN LAKES COMMUNITY SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:TWIN LAKES COMMUNITY SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSSP
Authorized Official - Phone:660-438-8599
Mailing Address - Street 1:16727 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-5750
Mailing Address - Country:US
Mailing Address - Phone:660-438-8599
Mailing Address - Fax:660-438-8584
Practice Address - Street 1:16727 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-5750
Practice Address - Country:US
Practice Address - Phone:660-438-8599
Practice Address - Fax:660-438-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8001556OtherDMH VENDER NUMBER