Provider Demographics
NPI:1073737433
Name:TRANSITION HOUSE INC
Entity Type:Organization
Organization Name:TRANSITION HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:810-232-2091
Mailing Address - Street 1:931 MARTIN LUTHER KING
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-1488
Mailing Address - Country:US
Mailing Address - Phone:810-232-2091
Mailing Address - Fax:810-232-2758
Practice Address - Street 1:931 MARTIN LUTHER KING
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1488
Practice Address - Country:US
Practice Address - Phone:810-232-2091
Practice Address - Fax:810-232-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI250041324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1705233Medicaid
MI250041OtherSTATE LICENSE