Provider Demographics
NPI:1295174480
Name:HEALTHY LIFE TRANSITIONS LLC
Entity type:Organization
Organization Name:HEALTHY LIFE TRANSITIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GROOMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-879-3443
Mailing Address - Street 1:1000 W WILSHIRE BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:405-879-3446
Practice Address - Street 1:1000 W WILSHIRE BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7030
Practice Address - Country:US
Practice Address - Phone:405-879-3443
Practice Address - Fax:405-879-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)