NPIMap

Organization Active NPI

Life Changez, Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Fuquay Varina, NC
National Provider Identifier
1912020637
Registry record updated Jul 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
MHL-092-795 Issued in NC
Legal business name
LIFE CHANGEZ, INC
Practice address
800 Perry Howard Rd
Fuquay Varina, NC 27526-1779
Phone
(919) 577-0021
Fax
(919) 803-2808
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2020

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

Authorized official

Name
Rene Whitehead
Title
Owner/Directo
Phone
(919) 803-2799

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Mental Illness Community Based Residential Treatment Facility 320800000X MHL-092-795 NC Primary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X

Addresses

Primary practice location

800 Perry Howard Rd
Fuquay Varina, NC 27526-1779

Mailing address

1100 Logger CT
Suite A102
Raleigh, NC 27609-8525
Phone (919) 803-2799

Other identifiers 1

IdentifierTypeStateIssuer
6604442MedicaidNC

Other names 1

  • Life Skills Independent Care Former legal business name

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": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593734400000",
    "number": "1912020637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 LOGGER CT",
            "address_2": "SUITE A102",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276098525",
            "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": "800 PERRY HOWARD RD",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275261779",
            "telephone_number": "919-577-0021",
            "fax_number": "919-803-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CHANGEZ, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-07-03",
        "certification_date": "2020-07-03",
        "status": "A",
        "authorized_official_last_name": "WHITEHEAD",
        "authorized_official_first_name": "RENE",
        "authorized_official_title_or_position": "OWNER/DIRECTO",
        "authorized_official_telephone_number": "919-803-2799"
    },
    "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": "NC",
            "license": "MHL-092-795",
            "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": "6604442",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Skills Independent Care",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Life Skills Independent Care",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fuquay Varina, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.