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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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