Provider Demographics
NPI:1619646023
Name:TRANSFORMATIONS FOR LIFE
Entity Type:Organization
Organization Name:TRANSFORMATIONS FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:BASSIOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:419-450-4771
Mailing Address - Street 1:4366 PEARSON PKWY
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3572
Mailing Address - Country:US
Mailing Address - Phone:419-450-4771
Mailing Address - Fax:
Practice Address - Street 1:4366 PEARSON PKWY
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3572
Practice Address - Country:US
Practice Address - Phone:419-450-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health