Organization
TRANSFORMATION HOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTIAN CHIESA (CEO)
(763) 452-7011
Entity
Organization
Contact information
Practice address
351 74TH AVE NE, FRIDLEY, MN 55432-3258
(763) 786-8172
Mailing address
1410 S FERRY RD, ANOKA, MN 55303-2164
(763) 427-7155
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
807288-3-CDT
MN
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
268217600
PROVIDER NUMBER
MN
Enumeration date
04/16/2007
Last updated
06/20/2023
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