Organization
A BASE 4 CHANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALLERY JOHNSON BSN (CEO)
(919) 799-3772
Entity
Organization
Contact information
Practice address
100 N. ASHLEY DR. SUITE 600, TAMPA, FL 33602
(919) 799-3772
Mailing address
1633 NEW GARDEN RD # 1088, GREENSBORO, NC 27410-2001
(919) 799-3772
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Enumeration date
06/30/2023
Last updated
06/30/2023
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