Provider Demographics
NPI:1508453887
Name:CHANGING LIVES
Entity Type:Organization
Organization Name:CHANGING LIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-337-2275
Mailing Address - Street 1:PO BOX 7405
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-0641
Mailing Address - Country:US
Mailing Address - Phone:623-337-2275
Mailing Address - Fax:623-440-6557
Practice Address - Street 1:17637 W BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2577
Practice Address - Country:US
Practice Address - Phone:623-337-2275
Practice Address - Fax:623-440-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness