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General NPI Number Information
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NPI Number | 1336434364
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Entity Type | Organization
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Legal Business Name | TRANSITIONAL LIVING CORPORATION
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 1313 S. VENICE AVE
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City | TUCSON
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State | AZ
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Zip | 85712-3935
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Country | US
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Telephone | 928-668-0722
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Fax |
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Provider Business Mailing Address
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Address Line | 466 W. WICKENBURG WAY
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City | WICKENBURG
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State | AZ
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Zip | 85390-2226
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Country | US
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Telephone | 928-668-0722
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | LEAH MARIE BRIICK
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Credential |
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Telephone | 928-668-0722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | BH2644
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License Number State | AZ
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