Provider Demographics
NPI:1508081506
Name:TRANSFORMATION HOUSE, INC.
Entity Type:Organization
Organization Name:TRANSFORMATION HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-452-7011
Mailing Address - Street 1:1410 S FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2164
Mailing Address - Country:US
Mailing Address - Phone:763-427-7155
Mailing Address - Fax:
Practice Address - Street 1:351 74TH AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3258
Practice Address - Country:US
Practice Address - Phone:763-786-8172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN807288-3-CDT324500000X
363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN268217600OtherPROVIDER NUMBER