Provider Demographics
NPI:1932815164
Name:TRANSFORMATIVE WELLNESS, LLC
Entity Type:Organization
Organization Name:TRANSFORMATIVE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:386-280-4877
Mailing Address - Street 1:533 N NOVA RD STE 116
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4421
Mailing Address - Country:US
Mailing Address - Phone:386-280-4877
Mailing Address - Fax:386-414-7227
Practice Address - Street 1:533 N NOVA RD STE 116
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4421
Practice Address - Country:US
Practice Address - Phone:386-280-4877
Practice Address - Fax:386-414-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care