| Life Change Outreach Organization | |
|
1135 Tenth St Suite A Clermont FL 34711 | |
| (352) 255-6458 | |
| Not Available |
| Full Name | Life Change Outreach Organization |
|---|---|
| Speciality | Case Manager/care Coordinator |
| Location | 1135 Tenth St, Clermont, Florida |
| Authorized Official Name and Position | Nabuchi Grace Anderson (OWNER) |
| Authorized Official Contact | 3522556458 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Change Outreach Organization Po Box 444 Mascotte FL 34753-0444 Ph: (352) 255-6458 | Life Change Outreach Organization 1135 Tenth St Suite A Clermont FL 34711 Ph: (352) 255-6458 |
| NPI Number | 1467704437 |
|---|---|
| Provider Enumeration Date | 10/15/2012 |
| Last Update Date | 10/15/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467704437 | NPI | - | NPPES |
| 004444700 | Medicaid | FL |
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