Healthcare Provider Details

I. General information

NPI: 1003607367
Provider Name (Legal Business Name): LIFE CHANGING WORLD OUTREACH COMMUNITY DEVELOPMENT CORPORATION INC
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

952 DECATUR ST
MEMPHIS TN
38107-2703
US

IV. Provider business mailing address

952 DECATUR ST
MEMPHIS TN
38107-2703
US

V. Phone/Fax

Practice location:
  • Phone: 901-779-0424
  • Fax:
Mailing address:
  • Phone: 901-779-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENDA A. FUTCH
Title or Position: CO-FOUNDER /EXECUTIVE DIRECTOR
Credential: PHD
Phone: 901-487-3954