Healthcare Provider Details

I. General information

NPI: 1689829293
Provider Name (Legal Business Name): LIFE CHANGEZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2856 CORNWALLIS RD
GARNER NC
27529-8140
US

IV. Provider business mailing address

1100 LOGGER CT SUITE A102
RALEIGH NC
27609-8525
US

V. Phone/Fax

Practice location:
  • Phone: 919-803-2799
  • Fax:
Mailing address:
  • Phone: 919-538-8920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-092-728
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS RENE COFER WHITEHEAD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-538-8920