Transitional Living Center Inc

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

1215 Issued in ND

Legal business name

TRANSITIONAL LIVING CENTER INC

Practice address

4399 88TH Ave NE
Devils Lake, ND 58301-8704

Phone

(701) 398-3031

Fax

(701) 398-3029

NPI assigned

Mar 29, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Robert Alan Spencer

Title

Chief of Operations

Phone

(701) 968-2646

Specialties & licenses 1

Addresses

Practitioners 4

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

• Glenda Springsted Spencer, LCSW, LAT

  • Clinical Social Worker
  • Powell, WY
  • NPI 1518050541
  NPD
• Stacey Lee Konzak, PA C

  • Physician Assistant
  • Bismarck, ND
  • NPI 1962486969
  NPD (past)
• Russell Petty, MD

  • Family Medicine Physician
  • Cando, ND
  • NPI 1043245277
  NPD (past)
• Erin Lee Sykora, OT

  • Mental Health Occupational Therapist
  • Devils Lake, ND
  • NPI 1033555420
  NPD (past)

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269820800000",
    "number": "1255656765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7448 68TH AVE NE",
            "city": "CANDO",
            "state": "ND",
            "postal_code": "583249485",
            "telephone_number": "701-968-2646",
            "fax_number": "701-968-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4399 88TH AVE NE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583018704",
            "telephone_number": "701-398-3031",
            "fax_number": "701-398-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRANSITIONAL LIVING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-29",
        "last_updated": "2010-03-29",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "CHIEF OF OPERATIONS",
        "authorized_official_telephone_number": "701-968-2646",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "ND",
            "license": "1215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Janelle Thompson, LSW
• Carlee Lynn Thomson, DNP, APRN, FNP-C
• William Frederick Thornton
• Alyssa Tofsrud
• Kristie Tollefson
• Patricia Trejo, OTR/L
• Destinee Tronnes
• Farrah Ann Trottier, RN
• Heather M Troy
• Leatha N Vaagen, PT

• All providers in Devils Lake, ND
• Substance Abuse Rehabilitation Facility in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.