Provider Demographics
NPI:1720611304
Name:LIFE CHANGES, INC.
Entity Type:Organization
Organization Name:LIFE CHANGES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM EVALUATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JERSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSCJ, PS
Authorized Official - Phone:775-200-8827
Mailing Address - Street 1:PO BOX 3137
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89432-3137
Mailing Address - Country:US
Mailing Address - Phone:775-200-8827
Mailing Address - Fax:
Practice Address - Street 1:1195 KINGS ROW
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-3524
Practice Address - Country:US
Practice Address - Phone:775-685-8145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty