Provider Demographics
NPI:1558834549
Name:TRANSFORMATIONAL LIFE CARE LLC
Entity Type:Organization
Organization Name:TRANSFORMATIONAL LIFE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:323-430-7954
Mailing Address - Street 1:711 E PALM AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2142
Mailing Address - Country:US
Mailing Address - Phone:323-430-7954
Mailing Address - Fax:
Practice Address - Street 1:711 E PALM AVE APT C
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2142
Practice Address - Country:US
Practice Address - Phone:234-607-9543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255646295OtherNPI