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General NPI Number Information
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NPI Number | 1366457087
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Entity Type | Organization
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Legal Business Name | TRANSITIONAL LIVING CENTERS, INC.
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 6721 GRAFTON ROAD SUITE 1
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City | VALLEY CITY
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State | OH
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Zip | 44280
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Country | US
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Telephone | 330-273-5494
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Fax | 330-273-6199
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Provider Business Mailing Address
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Address Line | 6721 GRAFTON ROAD SUITE 1
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City | VALLEY CITY
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State | OH
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Zip | 44280
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Country | US
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Telephone | 330-273-5494
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Fax | 330-273-6199
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Authorized Official
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Title or Position | PRESIDENT ADMINISTRATOR
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Name | DENISE T POZDERAC
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Credential | LNHA
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Telephone | 330-273-5494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 5210371
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License Number State | OH
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