MEDICARE: RAYS OF CHANGE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1003752718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYS OF CHANGE LLC

Provider Business Mailing Address
First Line	:	2119 CONGRESS ST APT 1
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40212-1631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 W BROADWAY STE 102
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-1303
Country	:	US
Telephone Number	:	216-484-3242
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RONNIE DORSEY
Credential	:
Telephone Number	:	216-484-3242

Provider Enumeration Date	:	04/25/2026
Last Update Date	:	04/29/2026

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Directions to “RAYS OF CHANGE LLC ” Practice Location

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