Provider Demographics
NPI:1043803299
Name:TRANSFORMATION HEALTH, LLC
Entity Type:Organization
Organization Name:TRANSFORMATION HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LANEY
Authorized Official - Last Name:BODDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-224-3002
Mailing Address - Street 1:376 CHESSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1319
Mailing Address - Country:US
Mailing Address - Phone:443-224-3002
Mailing Address - Fax:
Practice Address - Street 1:312 MARTIN LUTHER KING JR BLVD STE 103&300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1221
Practice Address - Country:US
Practice Address - Phone:443-759-9592
Practice Address - Fax:443-817-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health