Provider Demographics
NPI:1245954403
Name:CHANGING LIVES LLC
Entity type:Organization
Organization Name:CHANGING LIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-628-2887
Mailing Address - Street 1:8250 N GRAND CANYON DR UNIT 1147
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-3738
Mailing Address - Country:US
Mailing Address - Phone:702-406-7870
Mailing Address - Fax:
Practice Address - Street 1:8250 N GRAND CANYON DR UNIT 1147
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-3738
Practice Address - Country:US
Practice Address - Phone:702-406-7870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)