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Contact Information

LIFE CHANGE OUTREACH ORGANIZATION
1135 TENTH ST
SUITE A
CLERMONT, FL34711
 Phone: 352-255-6458
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Case Manager/Care Coordinator

171M00000X
 

Point of Service

305S00000X
 

Social Worker

104100000X
Indicates primary specialty

NPI Profile & details for LIFE CHANGE OUTREACH ORGANIZATION · (Female)

NPI # 1467704437
Status Active
Credentials
Entity Individual
Enumeration date 10/15/2012
Last updated 10/15/2012 - About 14 years ago
Sole proprietor 1 Not specified
Identifiers
  • FL Medicaid 004444700
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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