Organization
CHANGING LIVES GROUP HOME III, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAQUAY WADE (DIRECTOR)
(336) 516-6187
Entity
Organization
Contact information
Practice address
636 GUNN ST, BURLINGTON, NC 27217-1508
(336) 516-6187
Mailing address
823 DAY AVE, BURLINGTON, NC 27217-2505
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
NC
Other
Enumeration date
10/11/2016
Last updated
12/02/2016
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