Provider Demographics
NPI:1013287457
Name:CHANGES OF CHOICE, INC.
Entity Type:Organization
Organization Name:CHANGES OF CHOICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LANEDRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-328-1418
Mailing Address - Street 1:2223 STARLINE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5631
Mailing Address - Country:US
Mailing Address - Phone:404-328-1418
Mailing Address - Fax:404-328-1499
Practice Address - Street 1:2223 STARLINE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5631
Practice Address - Country:US
Practice Address - Phone:404-328-1418
Practice Address - Fax:404-328-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA338800744AOtherPROVIDER NUMBER