Healthcare Provider Details

I. General information

NPI: 1528937208
Provider Name (Legal Business Name): TRANSFORMING WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2025
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2997 NC HIGHWAY 210 W
HAMPSTEAD NC
28443-3481
US

IV. Provider business mailing address

2997 NC HIGHWAY 210 W
HAMPSTEAD NC
28443-3481
US

V. Phone/Fax

Practice location:
  • Phone: 708-362-1697
  • Fax: 813-271-0717
Mailing address:
  • Phone: 708-362-1697
  • Fax: 813-271-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DEMETRIA WADDELL
Title or Position: CEO
Credential: EDD
Phone: 708-362-1697