Provider Demographics
NPI:1538595632
Name:TRANSFORMATIVE LIFE CENTER, LLC.
Entity type:Organization
Organization Name:TRANSFORMATIVE LIFE CENTER, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEDAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-708-4605
Mailing Address - Street 1:134 W MATTHEWS ST
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1305
Mailing Address - Country:US
Mailing Address - Phone:704-708-4605
Mailing Address - Fax:
Practice Address - Street 1:134 W MATTHEWS ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1305
Practice Address - Country:US
Practice Address - Phone:704-708-4605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3909103T00000X
320800000X, 322D00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children