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Organization
TRANSITIONAL LIFE, LLC
Active
Organization
TRANSITIONAL LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE DENISE GOMEZ (CHIEF EXECUTIVE OFFICER)
(704) 904-1770
Entity
Organization
Contact information
Practice address
4202 PAINTED TRILLIUM CT, MATTHEWS, NC 28105-0120
(704) 904-1770
Mailing address
4202 PAINTED TRILLIUM CT, MATTHEWS, NC 28105-0120
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251S00000X
—
NC
Enumeration date
04/07/2017
Last updated
04/07/2017
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