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NPI Code Detail

MEDICARE: TRANSFORMATION CENTER-CLEVELAND

MEDICARE: TRANSFORMATION CENTER-CLEVELAND
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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11000000023616OTHERTNSTATE LICENSE

General Provider Information

NPI Number : 1215493978
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRANSFORMATION CENTER-CLEVELAND
Provider Business Mailing Address
First Line : 7209 HAMILTON ACRES CIR
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-8623
Country : US
Telephone Number : 423-499-9335
Fax Number : 423-499-9334
Provider Business Practice Location Address
First Line : 423 CENTRAL AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-4923
Country : US
Telephone Number : 423-476-1933
Fax Number : 423-559-1848
Authorized Official
Title or Position : DIRECTOR/PRESIDENT
Name : MR. MARK L. CARPENTER
Credential :
Telephone Number : 423-499-9335
Provider Enumeration Date : 02/18/2019
Last Update Date : 02/18/2019

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Directions to “TRANSFORMATION CENTER-CLEVELAND ” Practice Location

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