Provider Demographics
NPI:1881150969
Name:TWIN RIVER COMMUNITY LIVING FACILITY
Entity type:Organization
Organization Name:TWIN RIVER COMMUNITY LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-425-4515
Mailing Address - Street 1:201 DODD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-4757
Mailing Address - Country:US
Mailing Address - Phone:870-425-4515
Mailing Address - Fax:870-425-3933
Practice Address - Street 1:201 DODD ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4757
Practice Address - Country:US
Practice Address - Phone:870-425-4515
Practice Address - Fax:870-425-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125827767Medicaid
AR135313774Medicaid