Provider Demographics
NPI:1275419012
Name:TRANSFORMED THERAPY & WELLNESS CENTER
Entity type:Organization
Organization Name:TRANSFORMED THERAPY & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:773-888-9715
Mailing Address - Street 1:1439 W 105TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2930
Mailing Address - Country:US
Mailing Address - Phone:773-350-5764
Mailing Address - Fax:
Practice Address - Street 1:1439 W 105TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2930
Practice Address - Country:US
Practice Address - Phone:773-888-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty