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General NPI Number Information
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NPI Number | 1477068195
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Entity Type | Organization
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Legal Business Name | LIFE CHANGING SOLUTIONS
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3452 LIVE OAK HOLLOW DRIVE
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City | ORANGE PARK
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State | FL
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Zip | 32065-3206
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Country | US
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Telephone | 190-432-3301
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Fax | 904-323-3019
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Provider Business Mailing Address
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Address Line | 3452 LIVE OAK HOLLOW DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-2525
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MERLAND BAKER
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Credential |
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Telephone | 904-566-1955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 265852549
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | FL
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