Provider Demographics
NPI:1063863967
Name:TRANSFORMATION HEALTH LLC
Entity Type:Organization
Organization Name:TRANSFORMATION HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPH CPT, CLWMS
Authorized Official - Phone:850-696-8069
Mailing Address - Street 1:4051 E OLIVE RD APT 274
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6445
Mailing Address - Country:US
Mailing Address - Phone:850-696-8069
Mailing Address - Fax:
Practice Address - Street 1:4400 BAYOU BLVD STE 47-B3
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2673
Practice Address - Country:US
Practice Address - Phone:850-696-8069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty