Organization
LIFE CHANGING BEHAVIRAL HEALTH SER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS JOEL ROMAN (COO)
(910) 628-9091
Entity
Organization
Contact information
Practice address
314 S MAIN ST, FAIRMONT, NC 28340-1906
(910) 628-9091
(910) 628-9093
Mailing address
314 S MAIN ST, FAIRMONT, NC 28340-1906
(910) 628-9091
(910) 628-9093
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
07/23/2009
Last updated
03/13/2024
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