Provider Demographics
NPI:1356852313
Name:CHANGING EVERYDAY LIVES
Entity Type:Organization
Organization Name:CHANGING EVERYDAY LIVES
Other - Org Name:LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:DOMONIQUE
Authorized Official - Middle Name:LASHAWN
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:HOMECARE PROVIDER
Authorized Official - Phone:586-799-7079
Mailing Address - Street 1:45674 UTICA PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5926
Mailing Address - Country:US
Mailing Address - Phone:586-799-7079
Mailing Address - Fax:586-209-5513
Practice Address - Street 1:45674 UTICA PARK BLVD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48315-5926
Practice Address - Country:US
Practice Address - Phone:734-892-5458
Practice Address - Fax:586-209-5513
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========Medicaid
MA=========OtherMEDICARE