Provider Demographics
NPI:1356556799
Name:TWIN VALLEY DEVELOPMENTAL SERVICES,INC.
Entity type:Organization
Organization Name:TWIN VALLEY DEVELOPMENTAL SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-747-2251
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:413 COMMERCIAL ST.
Mailing Address - City:GREENLEAF
Mailing Address - State:KS
Mailing Address - Zip Code:66943
Mailing Address - Country:US
Mailing Address - Phone:785-747-2251
Mailing Address - Fax:785-747-2254
Practice Address - Street 1:413 COMMERCIAL ST.
Practice Address - Street 2:
Practice Address - City:GREENLEAF
Practice Address - State:KS
Practice Address - Zip Code:66943
Practice Address - Country:US
Practice Address - Phone:785-747-2251
Practice Address - Fax:785-747-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251C00000X, 320600000X
KS251B00000X, 320600000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100008280AMedicaid
KS100027240AMedicaid