Provider Demographics
NPI:1609353903
Name:CHANGING LIVES HOME CARE
Entity Type:Organization
Organization Name:CHANGING LIVES HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MISCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-580-1923
Mailing Address - Street 1:2633 PLUM RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7454
Mailing Address - Country:US
Mailing Address - Phone:910-580-1923
Mailing Address - Fax:910-223-7626
Practice Address - Street 1:2504 RAEFORD RD STE C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5135
Practice Address - Country:US
Practice Address - Phone:910-580-1923
Practice Address - Fax:910-223-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care