MEDICARE: TRANSFORM CENTRAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1093649154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORM CENTRAL INC.

Provider Business Mailing Address
First Line	:	1353 HONEYSUCKLE RD APT 1
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36305-1940
Country	:	US
Telephone Number	:	334-796-4506
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 HONEYSUCKLE RD APT 1
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36305-1940
Country	:	US
Telephone Number	:	334-796-4506
Fax Number	:

Authorized Official
Title or Position	:	MINISTER/EX. DIRECTOR
Name	:	MR. JASON JOHNSON
Credential	:	B.A. CRSS FBSS
Telephone Number	:	334-796-4506

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “TRANSFORM CENTRAL INC. ” Practice Location

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