Provider Demographics
NPI:1679218556
Name:CHANGING LIVES GROUP, LLC
Entity Type:Organization
Organization Name:CHANGING LIVES GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-883-1076
Mailing Address - Street 1:10500 CLEAR LAKE LOOP APT 105
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2395
Mailing Address - Country:US
Mailing Address - Phone:941-883-1076
Mailing Address - Fax:
Practice Address - Street 1:10500 CLEAR LAKE LOOP APT 105
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2395
Practice Address - Country:US
Practice Address - Phone:941-883-1076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health