Healthcare Provider Details

I. General information

NPI: 1750218756
Provider Name (Legal Business Name): LIFECHANGERS ACADEMY NORTHAMPTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5829 NORTHAMPTON BLVD
OMAHA NE
68104-1289
US

IV. Provider business mailing address

5829 NORTHAMPTON BLVD
OMAHA NE
68104-1289
US

V. Phone/Fax

Practice location:
  • Phone: 402-612-3318
  • Fax:
Mailing address:
  • Phone: 402-571-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVIDA JEAN ANDERSON
Title or Position: CEO
Credential: ANDERSON
Phone: 402-612-3318