Healthcare Provider Details

I. General information

NPI: 1467905166
Provider Name (Legal Business Name): TRANSFORMATION THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3668 TURTLE ISLAND CT
WEST PALM BEACH FL
33411-6444
US

IV. Provider business mailing address

3668 TURTLE ISLAND CT
WEST PALM BEACH FL
33411
US

V. Phone/Fax

Practice location:
  • Phone: 240-605-2882
  • Fax:
Mailing address:
  • Phone: 240-605-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSE CORETTA MERCHANT
Title or Position: PRESIDENT
Credential: PHD
Phone: 240-605-2882