NPIMap

Organization Active NPI

Life Change Institute, LLC.

  • Community/Behavioral Health Agency
  • Albuquerque, NM
National Provider Identifier
1962731174
Registry record updated Dec 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
I-06858 Issued in NM
Legal business name
LIFE CHANGE INSTITUTE, LLC.
Practice address
9301 Indian School Rd NE Ste 103
Albuquerque, NM 87112-2861
Phone
(505) 280-5860
Fax
(505) 294-3904
NPI assigned
Dec 17, 2009
Last updated
Dec 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2009

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

Authorized official

Name
Mrs. Shannon Enright-Smith, LISWNPI 1629199781
Title
Founder/Owner
Phone
(505) 280-5860

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X I-06858 NM Primary

Addresses

Primary practice location

9301 Indian School Rd NE Ste 103
Albuquerque, NM 87112-2861

Mailing address

9301 Indian School Rd NE Ste 103
Albuquerque, NM 87112-2861
Phone (505) 280-5860

National Provider Directory

National Provider Directory

Locations

9301 Indian School Rd NE
Ste 103
Albuquerque, NM 87112
Phone (505) 231-3965

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261008000000",
    "number": "1962731174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9301 INDIAN SCHOOL RD NE STE 103",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871122861",
            "telephone_number": "505-280-5860",
            "fax_number": "505-294-3904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9301 INDIAN SCHOOL RD NE STE 103",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871122861",
            "telephone_number": "505-280-5860",
            "fax_number": "505-294-3904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CHANGE INSTITUTE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-17",
        "last_updated": "2009-12-17",
        "status": "A",
        "authorized_official_last_name": "ENRIGHT-SMITH",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "FOUNDER/OWNER",
        "authorized_official_telephone_number": "505-280-5860",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NM",
            "license": "I-06858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; 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.