Healthcare Provider Details

I. General information

NPI: 1083382774
Provider Name (Legal Business Name): THE TRANSITION HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113-3115 INNOVATION DR
ST CLOUD FL
34769
US

IV. Provider business mailing address

3113-3115 INNOVATION DR
ST CLOUD FL
34769
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-5700
  • Fax: 321-805-4156
Mailing address:
  • Phone: 407-892-5700
  • Fax: 321-805-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA LUCAS
Title or Position: CEO
Credential: MBA, PHR, SHRM-CP
Phone: 407-892-5700