# CLEMENTINE TWIN LAKES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801375118
- **Authorized official:** MR. JASON SCHULZ (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (305) 663-1876

## Contact information

- **Practice address:** 13215 TWIN LAKES DR, CLIFTON, VA 20124-1215
- **Practice address phone:** (305) 663-1876
- **Practice address fax:** (914) 479-5490
- **Mailing address:** 6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
- **Mailing address phone:** (305) 663-1876
- **Mailing address fax:** (786) 359-4485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | NULL | — |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/08/2018
- **Last updated:** 02/16/2026