Provider Demographics
NPI:1598442576
Name:A BASE 4 CHANGE, LLC
Entity Type:Organization
Organization Name:A BASE 4 CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALLERY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:919-799-3772
Mailing Address - Street 1:1633 NEW GARDEN RD # 1088
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2001
Mailing Address - Country:US
Mailing Address - Phone:919-799-3772
Mailing Address - Fax:
Practice Address - Street 1:100 N. ASHLEY DR. SUITE 600
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602
Practice Address - Country:US
Practice Address - Phone:919-799-3772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service