Provider Demographics
NPI:1255496204
Name:TRANSCENDING MINDS
Entity Type:Organization
Organization Name:TRANSCENDING MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROADY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:336-499-7683
Mailing Address - Street 1:4407 PROVIDENCE LN STE C
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3264
Mailing Address - Country:US
Mailing Address - Phone:336-499-7683
Mailing Address - Fax:336-499-3952
Practice Address - Street 1:4407 PROVIDENCE LN STE C
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3264
Practice Address - Country:US
Practice Address - Phone:336-499-7683
Practice Address - Fax:336-499-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8301462251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301462Medicaid