Organization
LIFE CHANGEZ, INC
Active
Other names
Life Skills Independent Care
Organization subpart
No
Provider details
NPI number
Authorized official
RENE WHITEHEAD (OWNER/DIRECTO)
(919) 803-2799
Entity
Organization
Contact information
Practice address
800 PERRY HOWARD RD, FUQUAY VARINA, NC 27526-1779
(919) 577-0021
(919) 803-2808
Mailing address
1100 LOGGER CT, SUITE A102, RALEIGH, NC 27609-8525
(919) 803-2799
(919) 803-2808
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-092-795
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604442
—
NC
Enumeration date
04/09/2007
Last updated
07/03/2020
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