MEDICARE: TRANSITIONAL LIVING SERVICES, INC

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	:	1184923203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSITIONAL LIVING SERVICES, INC

Provider Business Mailing Address
First Line	:	2020 W WELLS ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2720
Country	:	US
Telephone Number	:	414-937-2020
Fax Number	:	414-937-2021

Provider Business Practice Location Address
First Line	:	3710 DOUGLAS AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3227
Country	:	US
Telephone Number	:	262-639-8084
Fax Number	:	262-639-8086

Authorized Official
Title or Position	:	VP FINANCE
Name	:	RICHARD ZALEWSKI
Credential	:
Telephone Number	:	414-937-2020

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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