Provider Demographics
NPI:1982061610
Name:CHANGING PLACES FAMILY CARE HOME OF DURHAM, LLC
Entity Type:Organization
Organization Name:CHANGING PLACES FAMILY CARE HOME OF DURHAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HATTIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:919-697-7340
Mailing Address - Street 1:725 HANSON ROAD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NORTH CAROLINA (NC)
Mailing Address - Zip Code:27713
Mailing Address - Country:UM
Mailing Address - Phone:919-248-0650
Mailing Address - Fax:919-908-8219
Practice Address - Street 1:725 HANSON RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1117
Practice Address - Country:US
Practice Address - Phone:919-697-7340
Practice Address - Fax:919-479-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities