Provider Demographics
NPI:1518646538
Name:TRANSFORMATIONAL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:TRANSFORMATIONAL HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTYL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-344-4549
Mailing Address - Street 1:111 TOWN SQUARE PL STE 1203
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2784
Mailing Address - Country:US
Mailing Address - Phone:888-344-4549
Mailing Address - Fax:908-652-9230
Practice Address - Street 1:111 TOWN SQUARE PL STE 1203
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-2784
Practice Address - Country:US
Practice Address - Phone:888-344-4549
Practice Address - Fax:908-652-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty