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NPI Code Detail

MEDICARE: LIFE CHANGING FAMILY CARE, LLC

MEDICARE: LIFE CHANGING FAMILY CARE, 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174232482
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFE CHANGING FAMILY CARE, LLC
Provider Business Mailing Address
First Line : 3411 OFFICE PARK DR
Second Line :
City : DAYTON
State : OH
Zip : 45439-2298
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3411 OFFICE PARK DR
Second Line :
City : DAYTON
State : OH
Zip : 45439-2298
Country : US
Telephone Number : 937-802-5440
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : AIOFIMI MARTIN
Credential :
Telephone Number : 937-802-5440
Provider Enumeration Date : 11/16/2022
Last Update Date : 10/21/2024

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Directions to “LIFE CHANGING FAMILY CARE, LLC ” Practice Location

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