MEDICARE: TRANSFORMATIONS WELLNESS CENTER

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1871176107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATIONS WELLNESS CENTER

Provider Business Mailing Address
First Line	:	3647 HIGHWAY 39
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-2612
Country	:	US
Telephone Number	:	541-884-5244
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 MAIN ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-6331
Country	:	US
Telephone Number	:	541-884-5244
Fax Number	:	541-884-1105

Authorized Official
Title or Position	:	CEO
Name	:	BARBARA ANN HEATH
Credential	:	MA, BS, CADC II
Telephone Number	:	541-884-5244

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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