Provider Demographics
NPI:1790419935
Name:LIFE CHANGING FAMILY CARE LLC
Entity Type:Organization
Organization Name:LIFE CHANGING FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MC KOY 'EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-670-4889
Mailing Address - Street 1:4001 FAYETTEVILLE RD.
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376
Mailing Address - Country:US
Mailing Address - Phone:910-670-4889
Mailing Address - Fax:
Practice Address - Street 1:4001 FAYETTEVILLE RD.
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376
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:2022-07-13
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health