Provider Demographics
NPI:1154906667
Name:TRANSFORMATIVE LIFE CENTER, LLC.
Entity type:Organization
Organization Name:TRANSFORMATIVE LIFE CENTER, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEDAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-927-5885
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28106-1200
Mailing Address - Country:US
Mailing Address - Phone:704-927-5885
Mailing Address - Fax:866-372-5885
Practice Address - Street 1:504 KINTYRE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4111
Practice Address - Country:US
Practice Address - Phone:704-708-4605
Practice Address - Fax:866-372-5885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSFORMATIVE LIFE CENTER, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-16
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children