# A BASE FOR CHANGE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568147072
- **Authorized official:** VALLERY JOHNSON BSN (CEO)
- **Authorized official phone:** (919) 799-3772

## Contact information

- **Practice address:** 100 S ASHLEY DR STE 600, TAMPA, FL 33602-5300
- **Practice address phone:** (919) 799-3772
- **Mailing address:** 1633 NEW GARDEN RD \# 1088, GREENSBORO, NC 27410-2001
- **Mailing address phone:** (919) 799-3772

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |

## Other

- **Enumeration date:** 06/21/2023
- **Last updated:** 06/21/2023