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General NPI Number Information
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NPI Number | 1780123331
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Entity Type | Organization
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Legal Business Name | LYFE CHANGES LLC
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 7415 GATEHOUSE CIR APT 180
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City | ORLANDO
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State | FL
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Zip | 32807-6011
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Country | US
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Telephone | 407-314-0383
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Fax | 407-964-3238
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Provider Business Mailing Address
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Address Line | 7415 GATEHOUSE CIR APT 180
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City | ORLANDO
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State | FL
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Zip | 32807-6011
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Country | US
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Telephone | 407-314-0383
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Fax | 407-964-3238
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JAMES J YOUNG
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Credential |
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Telephone | 407-314-0383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training 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 | 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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