Provider Demographics
NPI:1770274417
Name:TRANSITIONAL ONE LLC
Entity type:Organization
Organization Name:TRANSITIONAL ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-591-4455
Mailing Address - Street 1:231 S BEMISTON AVE STE 826
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1988
Mailing Address - Country:US
Mailing Address - Phone:148-541-3163
Mailing Address - Fax:314-854-1317
Practice Address - Street 1:231 S BEMISTON AVE STE 826
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1988
Practice Address - Country:US
Practice Address - Phone:314-854-1316
Practice Address - Fax:314-854-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care