MEDICARE: AMAZING CHANGES, 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	251S00000X	Community/Behavioral Health Agency		NC

General Provider Information

NPI Number	:	1841420890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING CHANGES, LLC

Provider Business Mailing Address
First Line	:	2421 CHARLES BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5925
Country	:	US
Telephone Number	:	252-341-3520
Fax Number	:	252-744-6302

Provider Business Practice Location Address
First Line	:	2421 CHARLES BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5925
Country	:	US
Telephone Number	:	252-341-3520
Fax Number	:	252-744-6302

Authorized Official
Title or Position	:	CEO
Name	:	MR. JAMES LAMONT BOWENS
Credential	:
Telephone Number	:	252-341-3520

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	07/23/2009

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Directions to “AMAZING CHANGES, LLC ” Practice Location

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