Provider Demographics
NPI:1730496266
Name:CHANGES FOR LIFE, LLC
Entity Type:Organization
Organization Name:CHANGES FOR LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDN
Authorized Official - Phone:203-532-5053
Mailing Address - Street 1:6 ELLIN DR
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-4976
Mailing Address - Country:US
Mailing Address - Phone:203-532-5053
Mailing Address - Fax:203-532-5053
Practice Address - Street 1:148 EAST AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5721
Practice Address - Country:US
Practice Address - Phone:203-532-5053
Practice Address - Fax:203-532-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000762133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty