Provider Demographics
NPI:1679194476
Name:LIFE CHANGING MISSIONS LLC
Entity Type:Organization
Organization Name:LIFE CHANGING MISSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-644-3597
Mailing Address - Street 1:1232 OLD GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-2955
Mailing Address - Country:US
Mailing Address - Phone:910-644-3597
Mailing Address - Fax:
Practice Address - Street 1:1232 OLD GREYSTONE DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-2955
Practice Address - Country:US
Practice Address - Phone:910-644-3597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty