1033822986 NPI number — TRANSFORMATION HEALTH, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033822986 NPI number — TRANSFORMATION HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANSFORMATION HEALTH, 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:
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:
1033822986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4083 DORSEYS RIDGE SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21043-5469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-224-3002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2288 BLUE WATER BLVD STE 315&317
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODENTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21113-3309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-759-9592
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BODDIE
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
LANEY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
443-224-3002

Provider Taxonomy Codes

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

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