Changing Lives Group Home III, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

CHANGING LIVES GROUP HOME III, LLC

Practice address

636 Gunn St
Burlington, NC 27217-1508

Phone

(336) 516-6187

NPI assigned

Oct 11, 2016

Last updated

Dec 2, 2016By the provider in NPPES

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 1

Addresses

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

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480636800000",
    "number": "1881144186",
    "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": "636 GUNN ST",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272171508",
            "telephone_number": "336-516-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGING LIVES GROUP HOME III, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-11",
        "last_updated": "2016-12-02",
        "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": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Central State of the Carolinas, Inc.
• CG Health Consulting PLLC
• Cham-Net Family Care Home
• Chang and Ramos II DDS PA
• Changing Lives Family Care Home LLC
• Don C Chaplin, M.D.
• Tyisha Chapman
• Alex Chappell, PHARMD
• Benjamin Charles Chasnis, M.D.
• Chatterbox Communication Connections, PLLC

• Adult Care Home Facility in Burlington, NC
• Providers in Burlington, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; 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.