Provider Demographics
NPI:1396778197
Name:TWIN CITIES COMMUNITY HOSPITAL, INC.
Entity type:Organization
Organization Name:TWIN CITIES COMMUNITY HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WARTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-546-7797
Mailing Address - Street 1:PO BOX 57446
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-7446
Mailing Address - Country:US
Mailing Address - Phone:209-578-2513
Mailing Address - Fax:805-434-2913
Practice Address - Street 1:1100 LAS TABLAS RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9704
Practice Address - Country:US
Practice Address - Phone:805-434-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000078282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
000438OtherHUMANA
050633B000000OtherSECTION 1011
CAZZT40633FMedicaid
ZZZA4003ZOtherBS OF CALIFORNIA
CAHSC30633FMedicaid
CAZZT40633GMedicaid
557290740OtherAETNA US HEALTHCARE
ZZZC4003ZOtherBS OF CALIFORNIA
005891-0002OtherPACIFICARE OF CALIFORNIA
CAHSC30633GMedicaid
CAZZT40633FMedicaid