MEDICARE: TRANSFORMATIONS FOR LIFE 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1619646023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATIONS FOR LIFE LLC

Provider Business Mailing Address
First Line	:	4366 PEARSON PKWY
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3572
Country	:	US
Telephone Number	:	419-450-4771
Fax Number	:

Provider Business Practice Location Address
First Line	:	4366 PEARSON PKWY
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3572
Country	:	US
Telephone Number	:	419-450-4771
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE DANA BASSIOUNI
Credential	:	PHYSICIAN ASSISTANT
Telephone Number	:	419-450-4771

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	06/17/2026

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Directions to “TRANSFORMATIONS FOR LIFE LLC ” Practice Location

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