Provider Demographics
NPI:1255656765
Name:TRANSITIONAL LIVING CENTER INC
Entity Type:Organization
Organization Name:TRANSITIONAL LIVING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-968-2646
Mailing Address - Street 1:7448 68TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANDO
Mailing Address - State:ND
Mailing Address - Zip Code:58324-9485
Mailing Address - Country:US
Mailing Address - Phone:701-968-2646
Mailing Address - Fax:701-968-2650
Practice Address - Street 1:4399 88TH AVE NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-8704
Practice Address - Country:US
Practice Address - Phone:701-398-3031
Practice Address - Fax:701-398-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1215324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility