Provider Demographics
NPI:1710498324
Name:TRANSITIONS WOMEN'S WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:TRANSITIONS WOMEN'S WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-299-3014
Mailing Address - Street 1:110 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-1233
Mailing Address - Country:US
Mailing Address - Phone:231-299-3014
Mailing Address - Fax:231-299-3025
Practice Address - Street 1:110 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1233
Practice Address - Country:US
Practice Address - Phone:231-299-3014
Practice Address - Fax:231-299-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196999176B00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty