Healthcare Provider Details

I. General information

NPI: 1457395212
Provider Name (Legal Business Name): TRANSITIONAL LIVING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 DOUGLAS AVE
RACINE WI
53402-3227
US

IV. Provider business mailing address

1040 S 70TH ST
MILWAUKEE WI
53214-3164
US

V. Phone/Fax

Practice location:
  • Phone: 262-639-8084
  • Fax: 262-639-8086
Mailing address:
  • Phone: 414-476-9675
  • Fax: 414-615-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT E WRENN
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 414-476-9631