Healthcare Provider Details

I. General information

NPI: 1861017162
Provider Name (Legal Business Name): TRANSFORMATION HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6212 YORK RD
BALTIMORE MD
21212-2612
US

IV. Provider business mailing address

6801 OAK HALL LN UNIT 6462
COLUMBIA MD
21045-7587
US

V. Phone/Fax

Practice location:
  • Phone: 240-374-3801
  • Fax: 410-755-7797
Mailing address:
  • Phone: 403-743-8012
  • Fax: 410-755-7797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CALISTA CHANA
Title or Position: CEO
Credential:
Phone: 240-374-3801