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LIFE CHANGEZ INC NPI 1730441775


NPI Information

NPI: 1730441775
Provider Name: LIFE CHANGEZ INC
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization
Address:
5321 LOGOS CT
RALEIGH, NC
ZIP 27610
Phone: (919) 803-7125
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LIFE CHANGEZ INC is a residential treatment facility emotionally disturbed children in Raleigh, NC. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. LIFE CHANGEZ INC NPI is 1730441775. The provider is registered as an organization entity type.

The provider's business location address is:

5321 LOGOS CT
RALEIGH, NC
ZIP 27610-481
Phone: (919) 803-7125
Fax: (919) 803-2808

The provider's authorized official is Rene Cofer Whitehead .
The authorized official title is Executive Director and has the following contact phone number (919) 538-8920.

The enumeration date for this NPI number is 6/14/2012 and was last updated on 3/10/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251S00000XCommunity/Behavioral HealthNo
2320800000XCommunity Based Residential Treatment Facility, Mental IllnessNo
3322D00000XResidential Treatment Facility, Emotionally Disturbed ChildrenMHL-092-844NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
16604442MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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