Provider Demographics
NPI:1386405439
Name:TRANSFORMATIVE CARE LLC
Entity type:Organization
Organization Name:TRANSFORMATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-609-2494
Mailing Address - Street 1:428 E 4TH ST STE 404
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2497
Mailing Address - Country:US
Mailing Address - Phone:919-609-2494
Mailing Address - Fax:
Practice Address - Street 1:428 E 4TH ST STE 404
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2497
Practice Address - Country:US
Practice Address - Phone:919-609-2494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility