Provider Demographics
NPI:1821383811
Name:TRANSITIONAL LIVING CORPORATION
Entity Type:Organization
Organization Name:TRANSITIONAL LIVING CORPORATION
Other - Org Name:GCC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRIICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-668-0722
Mailing Address - Street 1:466 W. WICKENBURG WAY
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2226
Mailing Address - Country:US
Mailing Address - Phone:928-668-1474
Mailing Address - Fax:
Practice Address - Street 1:431 S. ALARCON
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4394
Practice Address - Country:US
Practice Address - Phone:928-671-0475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSITIONAL LIVING CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2644324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility