Healthcare Provider Details

I. General information

NPI: 1669008736
Provider Name (Legal Business Name): TRANSFORMATIONS MENDING FENCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15530 W HIGHWAY 326
MORRISTON FL
32668-7311
US

IV. Provider business mailing address

PO BOX 733932
DALLAS TX
75373-3932
US

V. Phone/Fax

Practice location:
  • Phone: 561-501-5260
  • Fax:
Mailing address:
  • Phone: 561-501-5260
  • Fax: 954-982-6648

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: THOMAS HASSON
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 561-237-5306