Provider Demographics
NPI:1760031397
Name:TRANSFORMATION HEALTH, LLC
Entity Type:Organization
Organization Name:TRANSFORMATION HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LANEY
Authorized Official - Last Name:BODDIE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW-LCSW-C
Authorized Official - Phone:443-224-3002
Mailing Address - Street 1:312 MARTIN LUTHER KING JR BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1221
Mailing Address - Country:US
Mailing Address - Phone:443-224-3002
Mailing Address - Fax:443-815-0988
Practice Address - Street 1:312 MARTIN LUTHER KING JR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1221
Practice Address - Country:US
Practice Address - Phone:443-759-9592
Practice Address - Fax:443-815-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)