Provider Demographics
NPI:1184132433
Name:TRANSFORMING LIVES WITH CARE, INC
Entity type:Organization
Organization Name:TRANSFORMING LIVES WITH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OMORUYI
Authorized Official - Middle Name:EPHRAIM K
Authorized Official - Last Name:OKUNDAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCADC
Authorized Official - Phone:443-682-5807
Mailing Address - Street 1:2821 PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1228
Mailing Address - Country:US
Mailing Address - Phone:443-682-5807
Mailing Address - Fax:
Practice Address - Street 1:2821 PINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1228
Practice Address - Country:US
Practice Address - Phone:443-682-5807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17618251B00000X, 251S00000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health