Provider Demographics
NPI:1518610559
Name:1 LIFE CHANGES
Entity Type:Organization
Organization Name:1 LIFE CHANGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-506-4586
Mailing Address - Street 1:440 BURROUGHS ST STE 604
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3473
Mailing Address - Country:US
Mailing Address - Phone:248-785-8669
Mailing Address - Fax:
Practice Address - Street 1:440 BURROUGHS ST STE 604
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3473
Practice Address - Country:US
Practice Address - Phone:248-785-8669
Practice Address - Fax:855-746-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health