Healthcare Provider Details

I. General information

NPI: 1427088749
Provider Name (Legal Business Name): TRANSITIONS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N PELHAM ST
RHINELANDER WI
54501-3148
US

IV. Provider business mailing address

PO BOX 622
RHINELANDER WI
54501-0622
US

V. Phone/Fax

Practice location:
  • Phone: 715-365-6696
  • Fax: 715-365-6768
Mailing address:
  • Phone: 715-365-6696
  • Fax: 715-365-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4249-123
License Number StateWI

VIII. Authorized Official

Name: MR. RICHARD WAYNE MARTIN
Title or Position: DIRECTOR/OWNER
Credential: LCSW, LMFT,LPC,CADC
Phone: 715-365-6696