1154906667 NPI number — TRANSFORMATIVE LIFE CENTER, LLC.

Table of content: (NPI 1154906667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154906667 NPI number — TRANSFORMATIVE LIFE CENTER, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANSFORMATIVE LIFE CENTER, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154906667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTHEWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28106-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-927-5885
Provider Business Mailing Address Fax Number:
866-372-5885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 KINTYRE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28112-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-708-4605
Provider Business Practice Location Address Fax Number:
866-372-5885
Provider Enumeration Date:
03/16/2021

Additional Information

Authorized Official

Authorized Official Last Name:
LEDAY
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
704-927-5885

Provider Taxonomy Codes

  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com