Healthcare Provider Details

I. General information

NPI: 1710773304
Provider Name (Legal Business Name): 2018 LIFE CHANGERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 PHILLIPS AVE BLDG E
TOLEDO OH
43612-1351
US

IV. Provider business mailing address

515 N SAM HOUSTON PKWY E STE 208
HOUSTON TX
77060-4133
US

V. Phone/Fax

Practice location:
  • Phone: 832-683-1260
  • Fax:
Mailing address:
  • Phone: 832-683-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PRUDENCE M ALLEN
Title or Position: CEO
Credential:
Phone: 832-683-1260