Provider Demographics
NPI:1700422946
Name:LIFE CHANGING FAMILY CARE
Entity Type:Organization
Organization Name:LIFE CHANGING FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-670-4889
Mailing Address - Street 1:6883 PHILIPPI CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6129
Mailing Address - Country:US
Mailing Address - Phone:910-670-4889
Mailing Address - Fax:
Practice Address - Street 1:42 E RAHN RD STE 104
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5459
Practice Address - Country:US
Practice Address - Phone:910-670-4889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)