Provider Demographics
NPI:1700245008
Name:TWIN CITY CHRISTIAN HOMES SERVICES COMPANY
Entity Type:Organization
Organization Name:TWIN CITY CHRISTIAN HOMES SERVICES COMPANY
Other - Org Name:AVINITY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
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 STE 110
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-6008
Mailing Address - Country:US
Mailing Address - Phone:612-243-4585
Mailing Address - Fax:
Practice Address - Street 1:500 E. MONROE DRIVE
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:MN
Practice Address - Zip Code:55713
Practice Address - Country:US
Practice Address - Phone:218-258-8682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN372405251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health