Provider Demographics
NPI:1669082756
Name:TRANSFORMATIONAL HEALTHCARE SERVICES
Entity type:Organization
Organization Name:TRANSFORMATIONAL HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTYL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-344-4549
Mailing Address - Street 1:111 TOWN SQUARE PLACE
Mailing Address - Street 2:SUITE 1203 PMB 1039
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2784
Mailing Address - Country:US
Mailing Address - Phone:888-344-4549
Mailing Address - Fax:908-652-9230
Practice Address - Street 1:123 HIGHLAND AVE STE G2-A
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1527
Practice Address - Country:US
Practice Address - Phone:888-344-4549
Practice Address - Fax:908-652-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No333600000XSuppliersPharmacy