Provider Demographics
NPI:1518593805
Name:CHANGING LIVES PERSONAL CARE
Entity Type:Organization
Organization Name:CHANGING LIVES PERSONAL CARE
Other - Org Name:MCDOLE PERSONAL CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-309-0104
Mailing Address - Street 1:900 GRANBY ST STE 239
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2503
Mailing Address - Country:US
Mailing Address - Phone:757-309-0104
Mailing Address - Fax:757-257-0321
Practice Address - Street 1:900 GRANBY ST STE 239
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2503
Practice Address - Country:US
Practice Address - Phone:757-309-0104
Practice Address - Fax:757-257-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health