Provider Demographics
NPI:1992037535
Name:TRANSITIONS HOMES CORPORATION
Entity Type:Organization
Organization Name:TRANSITIONS HOMES CORPORATION
Other - Org Name:TRANSITIONS OUTPATIENT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JERRY
Authorized Official - Last Name:MUGAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-819-7207
Mailing Address - Street 1:1450 N WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356-9568
Mailing Address - Country:US
Mailing Address - Phone:612-819-7207
Mailing Address - Fax:888-239-3133
Practice Address - Street 1:366 PRIOR STREET
Practice Address - Street 2:SUITE #205
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-644-1304
Practice Address - Fax:888-239-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
MN1055581324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health