Basic Information
| Provider Information | |||||||||
| NPI: | 1427088749 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRANSITIONS CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 622 | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545010622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153656696 | ||||||||
| FaxNumber: | 7153656768 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 N PELHAM ST | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545013148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153656696 | ||||||||
| FaxNumber: | 7153656768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7153656696 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW, LMFT,LPC,CADC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4249-123 | WI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 42244000 | 05 | WI | MEDICAID |