Provider Demographics
NPI:1922714732
Name:CHANGING LIVES ENRICHMENT CENTER INC.
Entity Type:Organization
Organization Name:CHANGING LIVES ENRICHMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-730-9917
Mailing Address - Street 1:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-0947
Mailing Address - Country:US
Mailing Address - Phone:919-730-9917
Mailing Address - Fax:
Practice Address - Street 1:25 JENEE LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-2563
Practice Address - Country:US
Practice Address - Phone:919-730-9917
Practice Address - Fax:919-267-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home