Provider Demographics
NPI:1871929612
Name:TWIN TOWN CORPORATION
Entity type:Organization
Organization Name:TWIN TOWN CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LISONBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-629-9669
Mailing Address - Street 1:4388 KATELLA AVE.
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:866-594-8844
Mailing Address - Fax:562-493-1280
Practice Address - Street 1:4940 VAN NUYS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1700
Practice Address - Country:US
Practice Address - Phone:818-985-0560
Practice Address - Fax:818-985-7193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TWIN TOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190290BP261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder