Healthcare Provider Details

I. General information

NPI: 1356570501
Provider Name (Legal Business Name): TRANSITIONAL LIVING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S 70TH ST
MILWAUKEE WI
53214-3174
US

IV. Provider business mailing address

1040 S 70TH ST
MILWAUKEE WI
53214-3174
US

V. Phone/Fax

Practice location:
  • Phone: 414-476-9675
  • Fax: 414-615-0627
Mailing address:
  • Phone: 414-476-9675
  • Fax: 414-615-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: PEG DUBORD
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 414-476-9675