Provider Demographics
NPI:1952738999
Name:CHANGING LIVES NOW LLC
Entity type:Organization
Organization Name:CHANGING LIVES NOW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:MACON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:794-224-2364
Mailing Address - Street 1:3598 NC HIGHWAY 90 E
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-8273
Mailing Address - Country:US
Mailing Address - Phone:704-224-2364
Mailing Address - Fax:
Practice Address - Street 1:3598 NORTH CAROLINA 90
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681
Practice Address - Country:US
Practice Address - Phone:704-224-2364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-05
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-002-024322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children