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General NPI Number Information
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NPI Number | 1134394091
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Entity Type | Organization
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Legal Business Name | CHANGING LIVES: MIND, BODY, AND SOUL
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 1356 STRAWBERRY LN
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-4510
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Country | US
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Telephone | 954-274-8611
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Fax |
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Provider Business Mailing Address
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Address Line | 1356 STRAWBERRY LN
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-4510
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Country | US
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Telephone | 954-274-8611
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHRISTIANE PREVILMA
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Credential | BA
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Telephone | 954-274-8611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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