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
2856 CORNWALLIS RD, GARNER, NC 27529-8140
(919) 803-2799
Mailing address
1100 LOGGER CT, SUITE A102, RALEIGH, NC 27609-8525
(919) 538-8920
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL-092-728
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604373
—
NC
Enumeration date
11/24/2008
Last updated
12/30/2024
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