Provider Demographics
NPI:1134394091
Name:CHANGING LIVES: MIND, BODY, AND SOUL
Entity type:Organization
Organization Name:CHANGING LIVES: MIND, BODY, AND SOUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PREVILMA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:954-274-8611
Mailing Address - Street 1:1356 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-4510
Mailing Address - Country:US
Mailing Address - Phone:954-274-8611
Mailing Address - Fax:
Practice Address - Street 1:1356 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-4510
Practice Address - Country:US
Practice Address - Phone:954-274-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children