Provider Demographics
NPI:1568815264
Name:TRANSNET HOME GROUP;LLC
Entity Type:Organization
Organization Name:TRANSNET HOME GROUP;LLC
Other - Org Name:TRANSNET HOME GROUP MLK FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-965-7186
Mailing Address - Street 1:PO BOX 36266
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27416-6266
Mailing Address - Country:US
Mailing Address - Phone:336-965-7186
Mailing Address - Fax:888-821-5068
Practice Address - Street 1:1607 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-2423
Practice Address - Country:US
Practice Address - Phone:336-965-7186
Practice Address - Fax:888-821-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1448064171M00000X
NC0411145174200000X, 177F00000X, 251S00000X, 320800000X, 324500000X, 343900000X
320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No174200000XOther Service ProvidersMealsGroup - Single Specialty
No177F00000XOther Service ProvidersLodgingGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC246915141OMedicaid
NCMHL-041-1145OtherSTATE ISSUED: (IF APPLICABLE) CLEAR SAVE