Clementine Twin Lakes, LLC
NPI #1689269250 in Fairfax Station, Virginia
Provider Information
- NPI Number
- 1689269250
- Entity Type
- Organization
- Organization Name
- Clementine Twin Lakes, LLC
- Primary Specialty
- Psychiatric Residential Treatment Facility
- Enumeration Date
- Mar 5, 2021
- Last Updated
- Oct 16, 2025
Practice Location
- Address
- 11329 HENDERSON RD
- City
- Fairfax Station
- State
- Virginia
- ZIP Code
- 22039-2314
- Phone
- (305) 663-1876
Authorized Official
- Name
- MR. MIKE BAGLEY
- Title
- CHIEF FINANCIAL OFFICER
- Phone
- (305) 663-1876
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Mental Illness |
| Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health |
| Psychiatric Residential Treatment Facility |
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