MEDICARE: CHANGING LIVES GROUP, LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1679218556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGING LIVES GROUP, LLC

Provider Business Mailing Address
First Line	:	2444 BRAMAN AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7302
Country	:	US
Telephone Number	:	941-883-1076
Fax Number	:

Provider Business Practice Location Address
First Line	:	10500 CLEAR LAKE LOOP APT 105
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-2395
Country	:	US
Telephone Number	:	941-883-1076
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	ANNIE D WILLIAMS
Credential	:
Telephone Number	:	941-883-1076

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	01/29/2025

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