Provider Demographics
NPI:1053839217
Name:TRANSITIONAL LIFE CARE CLINIC, INC.
Entity type:Organization
Organization Name:TRANSITIONAL LIFE CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOOK
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:503-550-4750
Mailing Address - Street 1:15600 SW ROCK OF AGES RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8531
Mailing Address - Country:US
Mailing Address - Phone:971-261-6130
Mailing Address - Fax:971-261-6146
Practice Address - Street 1:15604 SW ROCK OF AGES RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8531
Practice Address - Country:US
Practice Address - Phone:971-261-6130
Practice Address - Fax:971-241-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty