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General NPI Number Information
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NPI Number | 1003607367
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Entity Type | Organization
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Legal Business Name | LIFE CHANGING WORLD OUTREACH COMMUNITY DEVELOPMENT CORPORATION INC
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 952 DECATUR ST
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City | MEMPHIS
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State | TN
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Zip | 38107-2703
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Country | US
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Telephone | 901-779-0424
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Fax |
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Provider Business Mailing Address
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Address Line | 952 DECATUR ST
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City | MEMPHIS
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State | TN
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Zip | 38107-2703
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Country | US
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Telephone | 901-779-0424
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER /EXECUTIVE DIRECTOR
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Name | DR. BRENDA A. FUTCH
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Credential | PHD
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Telephone | 901-487-3954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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