MEDICARE: RESIDENTIAL TRANSITIONS INCORPORATED

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144725623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL TRANSITIONS INCORPORATED

Provider Business Mailing Address
First Line	:	750 S PLAZA DR STE 100
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1505
Country	:	US
Telephone Number	:	651-457-1461
Fax Number	:	651-455-1385

Provider Business Practice Location Address
First Line	:	750 S PLAZA DR STE 100
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1505
Country	:	US
Telephone Number	:	651-457-1461
Fax Number	:	651-455-1385

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	STEPHEN ANTHONY DELONG
Credential	:	LICSW
Telephone Number	:	651-454-6118

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	10/07/2018

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