Provider Demographics
NPI:1396503538
Name:CHANGING COMMUNITIES LLC
Entity type:Organization
Organization Name:CHANGING COMMUNITIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-638-3353
Mailing Address - Street 1:634 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-1824
Mailing Address - Country:US
Mailing Address - Phone:919-638-3353
Mailing Address - Fax:919-869-2131
Practice Address - Street 1:1651 HIGHWAY 177
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:SC
Practice Address - Zip Code:29596-5310
Practice Address - Country:US
Practice Address - Phone:980-272-0063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health