NPIMap

Organization Active NPI

Transformation Station LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Baltimore, MD
National Provider Identifier
1982339180
Registry record updated Aug 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
TRANSFORMATION STATION LLC
Practice address
4200 Edmondson Ave Ste 100
Baltimore, MD 21229-1617
Phone
(443) 310-2572
NPI assigned
Jul 21, 2022
Last updated
Aug 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2023

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

Authorized official

Name
Mr. Darryl Moody
Title
Owner
Phone
(443) 310-2572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary

Addresses

Primary practice location

4200 Edmondson Ave Ste 100
Baltimore, MD 21229-1617

Mailing address

4200 Edmondson Ave Ste 100
Baltimore, MD 21229-1617
Phone (443) 310-2572

Other identifiers 1

IdentifierTypeStateIssuer
215JT87CMedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Transformation Station LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692316800000",
    "number": "1982339180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 EDMONDSON AVE STE 100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212291617",
            "telephone_number": "443-310-2572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 EDMONDSON AVE STE 100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212291617",
            "telephone_number": "443-310-2572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRANSFORMATION STATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-21",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-310-2572",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "215JT87C",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; 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.