Organization
TWIN DOVES II LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKIE LYNN HERNANDEZ (HOME PROVIDER)
(616) 403-9430
Entity
Organization
Contact information
Practice address
40739 80TH AVE, DECATUR, MI 49045-8158
(269) 852-5910
(269) 852-5910
Mailing address
48617 36TH AVE, BANGOR, MI 49013-9791
(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
11/15/2019
Last updated
11/15/2019
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