MEDICARE: HOUSE OF TRANSFORMATIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	174200000X	Meals Provider
3	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1932744489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE OF TRANSFORMATIONS

Provider Business Mailing Address
First Line	:	500 E TUDOR RD STE 220
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7377
Country	:	US
Telephone Number	:	907-333-2468
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E TUDOR RD STE 220
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7377
Country	:	US
Telephone Number	:	907-333-2468
Fax Number	:

Authorized Official
Title or Position	:	LEAD CASE MANAGER
Name	:	ENI I MAVAEGA
Credential	:
Telephone Number	:	907-297-8942

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	11/07/2019

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Directions to “HOUSE OF TRANSFORMATIONS ” Practice Location

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