MEDICARE: TRANSFORMATION SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1114264843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATION SERVICES

Provider Business Mailing Address
First Line	:	6400 OLD OAK RIDGE RD
Second Line	:	APT H14
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8539
Country	:	US
Telephone Number	:	919-924-4283
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 OLD OAK RIDGE RD
Second Line	:	APT H14
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8539
Country	:	US
Telephone Number	:	919-924-4283
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. TIMMIE MITCHELL
Credential	:
Telephone Number	:	919-924-4283

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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