Basic Information
| Provider Information | |||||||||
| NPI: | 1396778197 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TWIN CITIES COMMUNITY HOSPITAL, INC. | ||||||||
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| OtherOrganizationName: | TWIN CITIES COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 57446 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900747446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095782513 | ||||||||
| FaxNumber: | 8054342913 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 LAS TABLAS RD | ||||||||
| Address2: | |||||||||
| City: | TEMPLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934659704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054343500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | WARTELLE | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8055467797 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 050000078 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 000438 | 01 | HUMANA | OTHER | 050633B000000 | 01 | SECTION 1011 | OTHER | ZZT40633F | 05 | CA | MEDICAID | ZZZA4003Z | 01 | BS OF CALIFORNIA | OTHER | HSC30633F | 05 | CA | MEDICAID | ZZT40633G | 05 | CA | MEDICAID | 557290740 | 01 | AETNA US HEALTHCARE | OTHER | ZZZC4003Z | 01 | BS OF CALIFORNIA | OTHER | 005891-0002 | 01 | PACIFICARE OF CALIFORNIA | OTHER | HSC30633G | 05 | CA | MEDICAID |