Provider Demographics
NPI:1790403491
Name:HEALTHY TRANSITIONS, LLC
Entity Type:Organization
Organization Name:HEALTHY TRANSITIONS, LLC
Other - Org Name:HEALTHY TRANSITIONS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:LHMC
Authorized Official - Phone:850-259-8089
Mailing Address - Street 1:72 MOSAIC OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5499
Mailing Address - Country:US
Mailing Address - Phone:850-259-8089
Mailing Address - Fax:
Practice Address - Street 1:389 DORSEY AVE
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3013
Practice Address - Country:US
Practice Address - Phone:850-892-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1780344689Medicaid