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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

NPI Number 1467704437
LBN Legal business name LIFE CHANGE OUTREACH ORGANIZATION
Authorized official NABUCHI ANDERSON - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 10/15/2012
Last updated 10/15/2012 - About 14 years ago
Identifiers
FL Medicaid 004444700
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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