Provider Demographics
NPI:1992752471
Name:TRANSITIONAL LIFESTYLES COMMUNITY INC.
Entity type:Organization
Organization Name:TRANSITIONAL LIFESTYLES COMMUNITY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LINN
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-262-4230
Mailing Address - Street 1:11000 SPAIN RD NE
Mailing Address - Street 2:BLDING D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1883
Mailing Address - Country:US
Mailing Address - Phone:505-262-4230
Mailing Address - Fax:505-254-4664
Practice Address - Street 1:11000 SPAIN RD NE
Practice Address - Street 2:BLDING D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1883
Practice Address - Country:US
Practice Address - Phone:505-262-4230
Practice Address - Fax:505-254-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD-3235Medicaid