NPIMap

Organization Active NPI

Transformative Life Center, LLC.

  • Community/Behavioral Health Agency
  • Monroe, NC
National Provider Identifier
1154906667
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
TRANSFORMATIVE LIFE CENTER, LLC.
Practice address
504 Kintyre Dr
Monroe, NC 28112-4111
Phone
(704) 708-4605
Fax
(866) 372-5885
NPI assigned
Mar 16, 2021
Organization subpart
Yes
Parent organization
TRANSFORMATIVE LIFE CENTER, LLC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rose Marie Leday, PHDNPI 1679805717
Title
Ceo
Phone
(704) 927-5885

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary
Mental Illness Community Based Residential Treatment Facility 320800000X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X

Addresses

Primary practice location

504 Kintyre Dr
Monroe, NC 28112-4111

Mailing address

PO Box 1200
Matthews, NC 28106-1200
Phone (704) 927-5885

Other names 1

  • TRANSCEND ED ADOLESCENT RESIDENTIAL TREATMENT CENTER Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2337878Transcend Ed - Residential504 Kintyre Drive, Monroe, NC 28112Certificate of waiverFeb 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Transformative Life Center4 organizations share this tax ID, including this one
Part of
Transformative Life Center

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

200 W Matthews St
Matthews, NC 28105
Phone (704) 708-4605

130 W Matthews St
Ste A
Matthews, NC 28105
Phone (704) 708-4605

130 W Matthews St
Ste B
Matthews, NC 28105

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1154906667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1200",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281061200",
            "telephone_number": "704-927-5885",
            "fax_number": "866-372-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 KINTYRE DR",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281124111",
            "telephone_number": "704-708-4605",
            "fax_number": "866-372-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRANSFORMATIVE LIFE CENTER, LLC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRANSFORMATIVE LIFE CENTER, LLC.",
        "enumeration_date": "2021-03-16",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-08",
        "status": "A",
        "authorized_official_last_name": "LEDAY",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-927-5885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Transcend ED Adolescent Residential Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TRANSCEND ED ADOLESCENT RESIDENTIAL TREATMENT CENTER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TRANSCEND ED ADOLESCENT RESIDENTIAL TREATMENT CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Monroe, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.