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Organization
LIFE CHANGEZ INC
Active
Organization
LIFE CHANGEZ INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS RENE COFER WHITEHEAD (EXECUTIVE DIRECTOR)
(919) 538-8920
Entity
Organization
Contact information
Practice address
5321 LOGOS CT, RALEIGH, NC 27610-3481
(919) 803-7125
(919) 803-2808
Mailing address
1100 LOGGER CT STE A102, RALEIGH, NC 27609-8506
(919) 803-2799
(919) 803-2808
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-092-844
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604442
—
NC
Enumeration date
06/14/2012
Last updated
09/30/2025
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