Provider Demographics
NPI:1376917195
Name:LIVE CHANGE GROW CORPORATION
Entity Type:Organization
Organization Name:LIVE CHANGE GROW CORPORATION
Other - Org Name:LCG FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMYATTA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA, MBA
Authorized Official - Phone:216-242-9174
Mailing Address - Street 1:1700 W MARKET ST
Mailing Address - Street 2:NUM 190
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7002
Mailing Address - Country:US
Mailing Address - Phone:216-242-9174
Mailing Address - Fax:
Practice Address - Street 1:1440 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3610
Practice Address - Country:US
Practice Address - Phone:216-242-9174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251S00000XAgenciesCommunity/Behavioral Health