Organization
TWIN DOVES I LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKIE HERNANDEZ (OWNER)
(616) 403-9430
Entity
Organization
Contact information
Practice address
48617 36TH AVE., BANGOR, MI 49013
(616) 403-9430
(269) 852-5910
Mailing address
48617 36TH AVE., BANGOR, MI 49013
(616) 403-9430
(269) 852-5910
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/25/2020
Last updated
05/25/2020
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