MEDICARE: CHANGING MINDS INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251T00000X	PACE Provider Organization
2	310500000X	Mental Illness Intermediate Care Facility
3	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1861139370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGING MINDS INC

Provider Business Mailing Address
First Line	:	5417 EAGLE BEAD CV
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-4305
Country	:	US
Telephone Number	:	901-281-3425
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 CLIFFDALE CV
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-3514
Country	:	US
Telephone Number	:	901-281-3425
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TARA BROOKS
Credential	:	BACHELORS OF SW
Telephone Number	:	901-281-3425

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/16/2022

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Directions to “CHANGING MINDS INC ” Practice Location

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