MEDICARE: TRANSFORM A NATION 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1750015574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORM A NATION INC

Provider Business Mailing Address
First Line	:	901 N MILTON AVE STE 320
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205-1316
Country	:	US
Telephone Number	:	410-517-9883
Fax Number	:	443-438-4236

Provider Business Practice Location Address
First Line	:	901 N MILTON AVE STE 320
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205-1316
Country	:	US
Telephone Number	:	410-517-9883
Fax Number	:	443-438-4236

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/FOUNDER
Name	:	MS. TAMMY BRASWELL
Credential	:
Telephone Number	:	410-517-9883

Provider Enumeration Date	:	07/16/2022
Last Update Date	:	07/16/2022

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1144889569 — TRANSFORM A NATION INC
Practice Location Address:

901 N MILTON AVE # 320
BALTIMORE, MD
21205-1316

Practice Phone: 410-517-9883
Practice Fax:

Directions to “TRANSFORM A NATION INC ” Practice Location

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