Life Changez, Inc

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

LIFE CHANGEZ, INC

Practice address

2111 Maywood St
Greensboro, NC 27403-3107

Phone

(919) 803-2799

Fax

(919) 802-2808

NPI assigned

Nov 11, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rene WhiteheadNPI 1255105185

Title

Executive Director

Phone

(919) 538-8920

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rene Whitehead, MS, LCAS-A

  • Addiction (Substance Use Disorder) Counselor
  • Clayton, NC
  • NPI 1255105185
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605052800000",
    "number": "1184226409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 LOGGER CT STE A102",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276098506",
            "telephone_number": "919-538-8920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 MAYWOOD ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274033107",
            "telephone_number": "919-803-2799",
            "fax_number": "919-802-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CHANGEZ, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-11",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A",
        "authorized_official_last_name": "WHITEHEAD",
        "authorized_official_first_name": "RENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-538-8920"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689829293",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730441775",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Life Changes Family Services
• Life Changes Inc
• Life Enhancement Home Care LLC
• Life Source Medical, Inc.
• Life Structures, Inc.
• Life Structures, Inc.
• Lifepath, PLLC

• Mental Illness Community Based Residential Treatment Facility in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.