MEDICARE: TRANSITIONAL LIVING CORPORATION

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	324500000X	Substance Abuse Rehabilitation Facility	BH2644	AZ

General Provider Information

NPI Number	:	1336434364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSITIONAL LIVING CORPORATION

Provider Business Mailing Address
First Line	:	466 W. WICKENBURG WAY
Second Line	:
City	:	WICKENBURG
State	:	AZ
Zip	:	85390-2226
Country	:	US
Telephone Number	:	928-668-0722
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 S. VENICE AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3935
Country	:	US
Telephone Number	:	928-668-0722
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	LEAH MARIE BRIICK
Credential	:
Telephone Number	:	928-668-0722

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	06/17/2011

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Directions to “TRANSITIONAL LIVING CORPORATION ” Practice Location

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