Healthcare Provider Details

I. General information

NPI: 1093649154
Provider Name (Legal Business Name): TRANSFORM CENTRAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 HONEYSUCKLE RD APT 1
DOTHAN AL
36305-1940
US

IV. Provider business mailing address

1353 HONEYSUCKLE RD APT 1
DOTHAN AL
36305-1940
US

V. Phone/Fax

Practice location:
  • Phone: 334-796-4506
  • Fax:
Mailing address:
  • Phone: 334-796-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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