Provider Demographics
NPI:1801910344
Name:TWIN RIVERS INC.
Entity type:Organization
Organization Name:TWIN RIVERS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEUTZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-864-4545
Mailing Address - Street 1:20 VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-2040
Mailing Address - Country:US
Mailing Address - Phone:417-864-4545
Mailing Address - Fax:417-486-9452
Practice Address - Street 1:20 VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2040
Practice Address - Country:US
Practice Address - Phone:417-864-4545
Practice Address - Fax:417-869-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0053310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0485763Medicaid
165396Medicare ID - Type Unspecified