Provider Demographics
NPI:1295285682
Name:TWIN CITY CHRISTIAN HOMES SERVICES COMPANY
Entity type:Organization
Organization Name:TWIN CITY CHRISTIAN HOMES SERVICES COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:DENYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETHRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-243-4585
Mailing Address - Street 1:7645 LYNDALE AVE S
Mailing Address - Street 2:110
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-4084
Mailing Address - Country:US
Mailing Address - Phone:612-861-2799
Mailing Address - Fax:
Practice Address - Street 1:11201 FAIRFIELD RD W
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-7420
Practice Address - Country:US
Practice Address - Phone:952-512-0547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376645251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health