Healthcare Provider Details

I. General information

NPI: 1992037535
Provider Name (Legal Business Name): TRANSITIONS HOMES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 PRIOR STREET SUITE #205
ST. PAUL MN
55104
US

IV. Provider business mailing address

1450 N WILLOW DR
LONG LAKE MN
55356-9568
US

V. Phone/Fax

Practice location:
  • Phone: 651-644-1304
  • Fax: 888-239-3133
Mailing address:
  • Phone: 612-819-7207
  • Fax: 888-239-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1055581
License Number StateMN

VIII. Authorized Official

Name: MR. MICHAEL JERRY MUGAAS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 612-819-7207