Provider Demographics
NPI:1114116472
Name:HEALTHY TRANSITIONS, LLC
Entity Type:Organization
Organization Name:HEALTHY TRANSITIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUESSOW
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:908-647-1688
Mailing Address - Street 1:50 CHURCH ST STE L3
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2772
Mailing Address - Country:US
Mailing Address - Phone:908-647-1688
Mailing Address - Fax:908-647-1688
Practice Address - Street 1:50 CHURCH ST STE L3
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2772
Practice Address - Country:US
Practice Address - Phone:908-647-1688
Practice Address - Fax:908-647-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05818600261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA05818600OtherLICENSE