MEDICARE: TRANSITIONAL SERVICES SUB, LLC

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1275792418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSITIONAL SERVICES SUB, LLC

Provider Business Mailing Address
First Line	:	9000 KEYSTONE XING STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-2148
Country	:	US
Telephone Number	:	317-581-2380
Fax Number	:	317-581-2378

Provider Business Practice Location Address
First Line	:	1917 S LIBERTY DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-5146
Country	:	US
Telephone Number	:	812-334-4007
Fax Number	:	812-334-0217

Authorized Official
Title or Position	:	COO
Name	:	BRETT IAN COHEN
Credential	:
Telephone Number	:	800-388-5150

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	04/18/2023

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