| Life Changing Family Care, Llc | |
|
3411 Office Park Dr Kettering OH 45439-2298 | |
| (937) 802-5440 | |
| Not Available |
| Full Name | Life Changing Family Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3411 Office Park Dr, Kettering, Ohio |
| Authorized Official Name and Position | Aiofimi Martin (PRESIDENT) |
| Authorized Official Contact | 9378025440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Changing Family Care, Llc 3411 Office Park Dr Kettering OH 45439-2298 Ph: (937) 802-5440 | Life Changing Family Care, Llc 3411 Office Park Dr Kettering OH 45439-2298 Ph: (937) 802-5440 |
| NPI Number | 1972213700 |
|---|---|
| Provider Enumeration Date | 12/02/2022 |
| Last Update Date | 05/22/2024 |
| Certification Date | 05/22/2024 |
| Medicare PECOS PAC ID | 4486025186 |
|---|---|
| Medicare Enrollment ID | O20230117000794 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972213700 | NPI | - | NPPES |
| 0411413 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Brandy Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023592268 PECOS PAC ID: 2062832876 Enrollment ID: I20201016001322 |
| Provider Name | Felicia Poteate-marion |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437495199 PECOS PAC ID: 1658519673 Enrollment ID: I20230302002618 |
| Provider Name | Alieshia Harper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962186957 PECOS PAC ID: 5799122388 Enrollment ID: I20240319000398 |
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