Healthcare Provider Details

I. General information

NPI: 1598556953
Provider Name (Legal Business Name): LIFE CHANGING FAMILY CARE SERVICES II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 HARRIS AVE
RAEFORD NC
28376-3114
US

IV. Provider business mailing address

512 HARRIS AVE
RAEFORD NC
28376-3114
US

V. Phone/Fax

Practice location:
  • Phone: 937-287-7596
  • Fax: 937-802-5616
Mailing address:
  • Phone: 937-287-7596
  • Fax: 937-802-5616

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA EVANS
Title or Position: OWNER
Credential:
Phone: 910-670-4889