Organization
LIFE CENTER FOR CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. COLLEEN GRAY (OWNER)
(208) 745-0467
Entity
Organization
Contact information
Practice address
240 S 5TH W STE D, RIGBY, ID 83442-1476
(208) 745-0467
(208) 745-0409
Mailing address
240 S 5TH W STE D, RIGBY, ID 83442-1476
(208) 745-0467
(208) 745-0409
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/03/2006
Last updated
08/22/2020
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