Organization
LIFE CHANGE OUTREACH ORGANIZATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NABUCHI GRACE ANDERSON (OWNER)
(352) 255-6458
Entity
Organization
Contact information
Practice address
15508 WILLET CT, MASCOTTE, FL 34753-9102
(352) 255-6458
Mailing address
15508 WILLET CT, MASCOTTE, FL 34753-9102
(352) 255-6458
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/03/2012
Last updated
10/03/2012
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