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General NPI Number Information
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NPI Number | 1487278255
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Entity Type | Organization
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Legal Business Name | CHANGING LIVES FAMILY CARE LLC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 07/04/2025
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Provider Practice Location Address
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Address Line | 4406 INDIAN RIVER RD
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City | CHESAPEAKE
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State | VA
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Zip | 23325-3131
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Country | US
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Telephone | 912-247-9567
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Fax | 804-884-3702
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Provider Business Mailing Address
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Address Line | 4406 INDIAN RIVER RD
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City | CHESAPEAKE
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State | VA
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Zip | 23325-3131
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Country | US
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Telephone | 912-247-9567
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Fax | 804-884-3702
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Authorized Official
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Title or Position | OWNER
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Name | CATRINA BANKS
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Credential |
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Telephone | 912-247-9567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care 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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 385H00000X
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Taxonomy Name | Respite Care
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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