Living Change Corporation

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

CLA005765 Issued in GA

Legal business name

LIVING CHANGE CORPORATION

Practice address

301 Casteel Rd SW
Marietta, GA 30064-1611

Phone

(678) 570-0880

Fax

(678) 290-2850

NPI assigned

Aug 23, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Carol Coulthurst

Title

Ceo

Phone

(678) 570-0880

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534982400000",
    "number": "1902387400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 CASTEEL RD SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300641611",
            "telephone_number": "678-570-0880",
            "fax_number": "678-290-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 CASTEEL RD SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300641611",
            "telephone_number": "678-570-0880",
            "fax_number": "678-290-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING CHANGE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-23",
        "last_updated": "2018-08-23",
        "status": "A",
        "authorized_official_last_name": "COULTHURST",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-570-0880",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "GA",
            "license": "CLA005765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "587942289A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Marietta, GA
• Providers in Marietta, GA by specialty
• Developmentally Disabled Services Day Training Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2018; 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.