Organization
CHANGING LIVES NOW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD EARL MACON JR. (OWNER/DIRECTOR)
(794) 224-2364
Entity
Organization
Contact information
Practice address
3598 NORTH CAROLINA 90, TAYLORSVILLE, NC 28681
(704) 224-2364
Mailing address
3598 NC HIGHWAY 90 E, TAYLORSVILLE, NC 28681-8273
(704) 224-2364
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-002-024
NC
Other
Enumeration date
10/05/2013
Last updated
08/22/2014
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