Provider Demographics
NPI:1790256931
Name:CHANGE OF LIFE COMPANION HOMECARE LLC
Entity Type:Organization
Organization Name:CHANGE OF LIFE COMPANION HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR DIRECTOR (OWNER)
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATASHA D
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-307-7223
Mailing Address - Street 1:P.O. BOX 87242
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337
Mailing Address - Country:US
Mailing Address - Phone:404-307-7223
Mailing Address - Fax:
Practice Address - Street 1:401 TOPAZ TRAIL
Practice Address - Street 2:PEACHTREE CITY
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30269
Practice Address - Country:US
Practice Address - Phone:404-307-7223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty