Clementine Twin Lakes, LLC

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

CLEMENTINE TWIN LAKES, LLC

Practice address

13215 Twin Lakes Dr
Clifton, VA 20124-1215

Phone

(305) 663-1876

Fax

(914) 479-5490

NPI assigned

Aug 8, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jason Schulz

Title

Chief Financial Officer

Phone

(305) 663-1876

Specialties & licenses 3

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Clementine Twin Lakes LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Clementine Twin Lakes, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • MC Lean, VA
  • NPI 1033970603
  NPD tax ID
• Clementine Twin Lakes, LLC

  • Psychiatric Residential Treatment Facility
  • Fairfax Station, VA
  • NPI 1689269250
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771200000000",
    "number": "1801375118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 SW 76TH ST",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331435002",
            "telephone_number": "305-663-1876",
            "fax_number": "786-359-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13215 TWIN LAKES DR",
            "city": "CLIFTON",
            "state": "VA",
            "postal_code": "201241215",
            "telephone_number": "305-663-1876",
            "fax_number": "914-479-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMENTINE TWIN LAKES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-08",
        "last_updated": "2026-02-16",
        "certification_date": "2026-02-16",
        "status": "A",
        "authorized_official_last_name": "SCHULZ",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "305-663-1876",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Cavaluzzi
• Deborah Heylim Chung, DDS
• Alexander Clark, PA-C
• Lisa Clarkson, DPT, OCS, FMCP
• Classic Caregivers
• Gale Otello Cleveland, L.C.S.W.
• Morgan Cripe
• Dancing Tree Physical Therapy and Wellness, LLC
• Deborah Chung, D.D.S., PLLC
• Jessica Dye, OD

• Psychiatric Residential Treatment Facility in Clifton, VA
• Providers in Clifton, VA by specialty
• Psychiatric Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.