Changing Lives Group Home IV , LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

CHANGING LIVES GROUP HOME IV , LLC

Practice address

1404 Cushing St
Greensboro, NC 27405-3300

Phone

(336) 516-6187

NPI assigned

Jul 18, 2017

Organization subpart

No

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

Authorized official

Name

Jaquay Wade

Title

Director

Phone

(336) 516-6187

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1760905178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 DAY AVE",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272172505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 CUSHING ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274053300",
            "telephone_number": "336-516-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGING LIVES GROUP HOME IV , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-18",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "JAQUAY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-516-6187"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760905178",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Chang, M.D.
• Joe C. Chang, PA-C, L.AC
• Change Point Consultants, PLLC
• Change Therapeutic Services PLLC
• Changing Lives Group Home II LLC
• Changing Paths Counseling Center PLLC
• Changing Phases Behavioral Support
• Grace Faith Chao, M.D.
• Alexander Clayton Chapman
• Katherine Elizabeth Chapman, NP

• Community/Behavioral Health Agency in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Community/Behavioral Health Agency in North Carolina

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