| Changing Lives Group Home Iv , Llc | |
|
1404 Cushing St Greensboro NC 27405-3300 | |
| (336) 516-6187 | |
| Not Available |
| Full Name | Changing Lives Group Home Iv , Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1404 Cushing St, Greensboro, North Carolina |
| Authorized Official Name and Position | Jaquay Wade (DIRECTOR) |
| Authorized Official Contact | 3365166187 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Lives Group Home Iv , Llc 823 Day Ave Burlington NC 27217-2505 Ph: () - | Changing Lives Group Home Iv , Llc 1404 Cushing St Greensboro NC 27405-3300 Ph: (336) 516-6187 |
| NPI Number | 1760905178 |
|---|---|
| Provider Enumeration Date | 07/18/2017 |
| Last Update Date | 09/30/2020 |
| Certification Date | 09/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760905178 | NPI | - | NPPES |
| 1760905178 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 311ZA0620X | Custodial Care Facility - Adult Care Home | (* (Not Available)) | Secondary |
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