Healthcare Provider Details

I. General information

NPI: 1144983727
Provider Name (Legal Business Name): TRANSITIONAL HEALTH SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 HICKEY CT
CERES CA
95307-2026
US

IV. Provider business mailing address

PO BOX 579033
MODESTO CA
95357-9033
US

V. Phone/Fax

Practice location:
  • Phone: 209-324-9975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRA GOODRICH
Title or Position: CEO
Credential: RN
Phone: 209-324-9975