Healthcare Provider Details

I. General information

NPI: 1861149080
Provider Name (Legal Business Name): TRANSITIONS SUPPORTIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 MAHAN CENTER BLVD
TALLAHASSEE FL
32308-5454
US

IV. Provider business mailing address

1669 MAHAN CENTER BLVD
TALLAHASSEE FL
32308-5454
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-5310
  • Fax:
Mailing address:
  • Phone: 850-878-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BAXA
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 702-960-2272