MEDICARE: CHANGES OF CHOICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	338800744A	OTHER	GA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1013287457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGES OF CHOICE, INC.

Provider Business Mailing Address
First Line	:	2223 STARLINE DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-5631
Country	:	US
Telephone Number	:	404-328-1418
Fax Number	:	404-328-1499

Provider Business Practice Location Address
First Line	:	2223 STARLINE DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-5631
Country	:	US
Telephone Number	:	404-328-1418
Fax Number	:	404-328-1499

Authorized Official
Title or Position	:	CEO
Name	:	MISS LANEDRA N MANNING
Credential	:
Telephone Number	:	404-328-1418

Provider Enumeration Date	:	01/02/2012
Last Update Date	:	01/02/2012

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Directions to “CHANGES OF CHOICE, INC. ” Practice Location

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