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General NPI Number Information
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NPI Number | 1659413581
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Entity Type | Organization
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Legal Business Name | CHANGING HEARTS INSTEAD OF LOSING LIVES, INC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 713 FOREST ROAD
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City | PLYMOUTH
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State | NC
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Zip | 27962
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Country | US
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Telephone | 252-791-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 713 FORREST RD
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City | PLYMOUTH
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State | NC
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Zip | 27962-2256
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Country | US
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Telephone | 252-791-0909
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HAMDIYA MOORE
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Credential |
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Telephone | 252-791-0909
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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 |
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License Number State |
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