Healthcare Provider Details

I. General information

NPI: 1508633421
Provider Name (Legal Business Name): CHANGING LIVES FAMILY CARE FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97689 ALBATROSS DR
YULEE FL
32097-3615
US

IV. Provider business mailing address

97689 ALBATROSS DR
YULEE FL
32097-3615
US

V. Phone/Fax

Practice location:
  • Phone: 912-335-5305
  • Fax:
Mailing address:
  • Phone: 912-335-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CATRINA BANKS
Title or Position: OWNER
Credential:
Phone: 912-247-9567