Provider Demographics
NPI:1790501872
Name:TRANSFORM LIVES LLC
Entity type:Organization
Organization Name:TRANSFORM LIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUSUF
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-203-4974
Mailing Address - Street 1:1250 MOORE LAKE DR E STE 150
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5135
Mailing Address - Country:US
Mailing Address - Phone:763-203-4974
Mailing Address - Fax:
Practice Address - Street 1:1250 MOORE LAKE DR E STE 150
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5135
Practice Address - Country:US
Practice Address - Phone:763-203-4974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-23
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder