# TRANSFORMATION360

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073026662
- **Authorized official:** ALICE DELIA PETERSON (OWNER)
- **Authorized official phone:** (702) 628-1223

## Contact information

- **Practice address:** 5025 HOSTETLER AVE, LAS VEGAS, NV 89131-1981
- **Practice address phone:** (702) 628-1223
- **Mailing address:** 5025 HOSTETLER AVE, LAS VEGAS, NV 89131-1981
- **Mailing address phone:** (702) 628-1223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |

## Other

- **Enumeration date:** 11/06/2017
- **Last updated:** 11/20/2017