# CHANGING LIVES GROUP HOME III, LLC

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

## Provider details

- **NPI number:** 1881144186
- **Authorized official:** JAQUAY WADE (DIRECTOR)
- **Authorized official phone:** (336) 516-6187

## Contact information

- **Practice address:** 636 GUNN ST, BURLINGTON, NC 27217-1508
- **Practice address phone:** (336) 516-6187
- **Mailing address:** 823 DAY AVE, BURLINGTON, NC 27217-2505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NC | Yes |

## Other

- **Enumeration date:** 10/11/2016
- **Last updated:** 12/02/2016