Provider Demographics
NPI:1639456338
Name:TRANSITIONS BEHAVIORAL AND SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:TRANSITIONS BEHAVIORAL AND SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, DIRECTOR OF SUPPORT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAWANNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LUMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-284-0055
Mailing Address - Street 1:10507 NW 146TH PL
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-5723
Mailing Address - Country:US
Mailing Address - Phone:352-284-0055
Mailing Address - Fax:386-462-1795
Practice Address - Street 1:10507 NW 146TH PL
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5723
Practice Address - Country:US
Practice Address - Phone:352-284-0055
Practice Address - Fax:386-462-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-05-1666251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL751351898Medicaid
FL751351896Medicaid