Provider Demographics
NPI:1922201565
Name:TRANSFORMATIONAL LIVING CENTERS
Entity Type:Organization
Organization Name:TRANSFORMATIONAL LIVING CENTERS
Other - Org Name:TRANSFORMATIONAL LIVING CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-988-6168
Mailing Address - Street 1:2851 E MANOA RD
Mailing Address - Street 2:SUITE 1-203
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1858
Mailing Address - Country:US
Mailing Address - Phone:808-988-6168
Mailing Address - Fax:808-955-8155
Practice Address - Street 1:2851 E MANOA RD
Practice Address - Street 2:SUITE 1-203
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1858
Practice Address - Country:US
Practice Address - Phone:808-988-6168
Practice Address - Fax:808-955-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-375251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0032233OtherHMSA
HI25083201Medicaid
HI0000032235OtherHMSA
HIS24640Medicare UPIN
HI0000TCCCKMedicare ID - Type Unspecified