Provider Demographics
NPI:1912086752
Name:TWIN OAKS COMMUNITY SERVICES
Entity Type:Organization
Organization Name:TWIN OAKS COMMUNITY SERVICES
Other - Org Name:FAMILY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TIESHAU
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLEBROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:856-254-3800
Mailing Address - Street 1:57 HADDONFIELD RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-4813
Mailing Address - Country:US
Mailing Address - Phone:856-254-3800
Mailing Address - Fax:
Practice Address - Street 1:57 HADDONFIELD RD
Practice Address - Street 2:SUITE 125
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-4813
Practice Address - Country:US
Practice Address - Phone:856-324-5186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ657503Medicare UPIN