Provider Demographics
NPI:1255916367
Name:TRANSFORMATION HEALTHCARE INC.
Entity type:Organization
Organization Name:TRANSFORMATION HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CALISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-878-1084
Mailing Address - Street 1:326 SAINT PAUL ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2166
Mailing Address - Country:US
Mailing Address - Phone:240-374-3801
Mailing Address - Fax:410-755-7797
Practice Address - Street 1:3213 HOWARD PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-6757
Practice Address - Country:US
Practice Address - Phone:410-878-1085
Practice Address - Fax:410-755-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness