Provider Demographics
NPI:1124350996
Name:TWIN CITY CHEMICAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:TWIN CITY CHEMICAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:651-495-9494
Mailing Address - Street 1:858 TERRACE CT STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-4276
Mailing Address - Country:US
Mailing Address - Phone:651-495-9494
Mailing Address - Fax:952-997-6569
Practice Address - Street 1:858 TERRACE CT STE B
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-4276
Practice Address - Country:US
Practice Address - Phone:651-495-9494
Practice Address - Fax:952-997-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1053675-1-CDT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health