NPIMap

Organization Active NPI

Life Changez Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Raleigh, NC
National Provider Identifier
1730441775
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL-092-844 Issued in NC
Legal business name
LIFE CHANGEZ INC
Practice address
5321 Logos CT
Raleigh, NC 27610-3481
Phone
(919) 803-7125
Fax
(919) 803-2808
NPI assigned
Jun 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Authorized official

Name
Miss Rene Cofer Whitehead
Title
Executive Director
Phone
(919) 538-8920

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Mental Illness Community Based Residential Treatment Facility 320800000X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-092-844 NC Primary

Addresses

Primary practice location

5321 Logos CT
Raleigh, NC 27610-3481

Mailing address

1100 Logger CT Ste A102
Raleigh, NC 27609-8506
Phone (919) 803-2799

Other practice location 1

7 W Edgerton St
Smithfield, NC 27577-4707
Phone (919) 538-8920

Other identifiers 1

IdentifierTypeStateIssuer
6604442MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Life Changez Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759190400000",
    "number": "1730441775",
    "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": "919-803-2799",
            "fax_number": "919-803-2808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5321 LOGOS CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276103481",
            "telephone_number": "919-803-7125",
            "fax_number": "919-803-2808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7 W Edgerton St",
            "address_purpose": "LOCATION",
            "city": "Smithfield",
            "state": "NC",
            "postal_code": "275774707",
            "country_code": "US",
            "telephone_number": "919-538-8920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE CHANGEZ INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-14",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A",
        "authorized_official_last_name": "WHITEHEAD",
        "authorized_official_first_name": "RENE",
        "authorized_official_middle_name": "COFER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-538-8920",
        "authorized_official_name_prefix": "Miss"
    },
    "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": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-092-844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604442",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; 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.