Healthcare Provider Details

I. General information

NPI: 1124691944
Provider Name (Legal Business Name): TRANSFORMATIONS CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18726 S WESTERN AVE STE 209
GARDENA CA
90248-3813
US

IV. Provider business mailing address

18726 S WESTERN AVE STE 209
GARDENA CA
90248-3813
US

V. Phone/Fax

Practice location:
  • Phone: 310-946-8433
  • Fax:
Mailing address:
  • Phone: 310-946-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: PAUL DILLENBACK
Title or Position: CEO
Credential:
Phone: 310-946-8433