Provider Demographics
NPI:1356990501
Name:TRANSFORMCARE, INC
Entity type:Organization
Organization Name:TRANSFORMCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-264-5789
Mailing Address - Street 1:3400 W MARSHALL AVE STE 428
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-5077
Mailing Address - Country:US
Mailing Address - Phone:903-806-6674
Mailing Address - Fax:
Practice Address - Street 1:7811 MONTROSE RD STE 410
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3347
Practice Address - Country:US
Practice Address - Phone:240-264-5789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care