Provider Demographics
NPI:1679697445
Name:TWIN RIVERS DEVELOPMENTAL SUPPORTS INC
Entity type:Organization
Organization Name:TWIN RIVERS DEVELOPMENTAL SUPPORTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-442-3575
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-0133
Mailing Address - Country:US
Mailing Address - Phone:620-442-3575
Mailing Address - Fax:620-442-3733
Practice Address - Street 1:22179 D STREET
Practice Address - Street 2:STROTHER FIELD INDUSTRIAL PARK
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-0133
Practice Address - Country:US
Practice Address - Phone:620-442-3575
Practice Address - Fax:620-442-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100362030BMedicaid
KS100362030AMedicaid