Provider Demographics
NPI:1003607367
Name:LIFE CHANGING WORLD OUTREACH COMMUNITY DEVELOPMENT CORPORATION INC
Entity type:Organization
Organization Name:LIFE CHANGING WORLD OUTREACH COMMUNITY DEVELOPMENT CORPORATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER /EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-487-3954
Mailing Address - Street 1:952 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-2703
Mailing Address - Country:US
Mailing Address - Phone:901-779-0424
Mailing Address - Fax:
Practice Address - Street 1:952 DECATUR ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-2703
Practice Address - Country:US
Practice Address - Phone:901-779-0424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility