Provider Demographics
NPI:1588864359
Name:TRANSITIONAL LIVING CENTERS, INC
Entity type:Organization
Organization Name:TRANSITIONAL LIVING CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:T
Authorized Official - Last Name:POZDERAC
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-273-5494
Mailing Address - Street 1:6721 GRAFTON ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VALLEY CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44280
Mailing Address - Country:US
Mailing Address - Phone:330-273-5494
Mailing Address - Fax:330-273-6199
Practice Address - Street 1:6721 GRAFTON ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:VALLEY CITY
Practice Address - State:OH
Practice Address - Zip Code:44280
Practice Address - Country:US
Practice Address - Phone:330-273-5494
Practice Address - Fax:330-273-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5211247347C00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5211247OtherOHIO DEPARTMENT OF MRDD
OH2728883Medicaid