MEDICARE: TRANSITIONAL ONE LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1770274417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSITIONAL ONE LLC

Provider Business Mailing Address
First Line	:	231 S BEMISTON AVE STE 826
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-1988
Country	:	US
Telephone Number	:	148-541-3163
Fax Number	:	314-854-1317

Provider Business Practice Location Address
First Line	:	231 S BEMISTON AVE STE 826
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-1988
Country	:	US
Telephone Number	:	314-854-1316
Fax Number	:	314-854-1317

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ANTHONY WALLS
Credential	:
Telephone Number	:	314-591-4455

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	05/22/2023

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Directions to “TRANSITIONAL ONE LLC ” Practice Location

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