Provider Demographics
NPI:1629818273
Name:LIFE CHANGERS LLC
Entity type:Organization
Organization Name:LIFE CHANGERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,CADC
Authorized Official - Phone:773-531-9571
Mailing Address - Street 1:4937 S SAINT LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3389
Mailing Address - Country:US
Mailing Address - Phone:773-531-9571
Mailing Address - Fax:773-901-2363
Practice Address - Street 1:8543 S STONY ISLAND AVE STE 5
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2249
Practice Address - Country:US
Practice Address - Phone:773-633-1964
Practice Address - Fax:773-901-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty