Provider Demographics
NPI:1871723486
Name:LIFE CHANGES FAMILY SERVICES
Entity type:Organization
Organization Name:LIFE CHANGES FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:716-390-8358
Mailing Address - Street 1:3229 REGENTS PARK LN
Mailing Address - Street 2:APT D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1838
Mailing Address - Country:US
Mailing Address - Phone:716-390-8358
Mailing Address - Fax:
Practice Address - Street 1:WEST FRIENDLY AVE
Practice Address - Street 2:5415 SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455
Practice Address - Country:US
Practice Address - Phone:716-390-8358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health