Healthcare Provider Details

I. General information

NPI: 1508642018
Provider Name (Legal Business Name): TNT TRANSFORMATION HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CLAPP ST
GRAHAM NC
27253-3111
US

IV. Provider business mailing address

813 WILLIAMS ST
BURLINGTON NC
27217-1652
US

V. Phone/Fax

Practice location:
  • Phone: 743-208-3119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY BRADSHER
Title or Position: DIRECTOR
Credential:
Phone: 743-208-3119