1922201565 NPI number — TRANSFORMATIONAL LIVING CENTERS

Table of content: (NPI 1922201565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922201565 NPI number — TRANSFORMATIONAL LIVING CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANSFORMATIONAL LIVING CENTERS
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:
TRANSFORMATIONAL LIVING CENTERS
Provider Other Organization Name Type Code:
3
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:
1922201565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2851 E MANOA RD
Provider Second Line Business Mailing Address:
SUITE 1-203
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96822-1858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-988-6168
Provider Business Mailing Address Fax Number:
808-955-8155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2851 E MANOA RD
Provider Second Line Business Practice Location Address:
SUITE 1-203
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96822-1858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-988-6168
Provider Business Practice Location Address Fax Number:
808-955-8155
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STURGIS
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-988-6168

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  PSY-375 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A0032233 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 25083201 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000032235 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com