Organization
LIFE CHANGEZ, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENE WHITEHEAD (EXECUTIVE DIRECTOR)
(919) 538-8920
Entity
Organization
Contact information
Practice address
2111 MAYWOOD ST, GREENSBORO, NC 27403-3107
(919) 803-2799
(919) 802-2808
Mailing address
1100 LOGGER CT STE A102, RALEIGH, NC 27609-8506
(919) 538-8920
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689829293
—
NC
05
—
1730441775
—
NC
Enumeration date
11/11/2020
Last updated
11/11/2020
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