MEDICARE: 4-EVER CHANGE SERVICES, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1134350812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4-EVER CHANGE SERVICES, INC.

Provider Business Mailing Address
First Line	:	5033 UNIVERSITY PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-6083
Country	:	US
Telephone Number	:	336-661-3058
Fax Number	:	336-661-3059

Provider Business Practice Location Address
First Line	:	5033 UNIVERSITY PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-6083
Country	:	US
Telephone Number	:	336-661-3058
Fax Number	:	336-661-3059

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTOPHER BROWN
Credential	:	B.A./QP
Telephone Number	:	336-986-3158

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

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