Provider Demographics
NPI:1932744489
Name:HOUSE OF TRANSFORMATIONS
Entity Type:Organization
Organization Name:HOUSE OF TRANSFORMATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ENI
Authorized Official - Middle Name:I
Authorized Official - Last Name:MAVAEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-297-8942
Mailing Address - Street 1:500 E TUDOR RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7377
Mailing Address - Country:US
Mailing Address - Phone:907-333-2468
Mailing Address - Fax:
Practice Address - Street 1:500 E TUDOR RD STE 220
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7377
Practice Address - Country:US
Practice Address - Phone:907-333-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals