Healthcare Provider Details

I. General information

NPI: 1851113849
Provider Name (Legal Business Name): TRANSFORMATIONAL HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HIGHLAND AVE SUITE G2
GLEN RIDGE NJ
07028
US

IV. Provider business mailing address

123 HIGHLAND AVE SUITE G2
GLEN RIDGE NJ
07028
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-4549
  • Fax: 908-652-9230
Mailing address:
  • Phone: 888-344-4549
  • Fax: 908-652-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SIMEON MERTYL
Title or Position: DIRECTOR
Credential:
Phone: 888-344-4549