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General NPI Number Information
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NPI Number | 1376950469
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Entity Type | Organization
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Legal Business Name | TRANSFORMATION HOUSE, INC.
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 361 74TH AVE NE
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City | FRIDLEY
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State | MN
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Zip | 55432-3258
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Country | US
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Telephone | 763-427-7155
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 S FERRY ST
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City | ANOKA
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State | MN
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Zip | 55303-2152
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Country | US
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Telephone | 763-426-7155
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Fax | 763-427-6084
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Authorized Official
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Title or Position | CEO
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Name | CRISTIAN CHIESA
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Credential |
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Telephone | 763-452-7011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 10739571CDT
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License Number State | MN
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