Provider Demographics
NPI:1932947280
Name:CHANGING LIVES BEHAVIORAL SUPPORT CORP
Entity type:Organization
Organization Name:CHANGING LIVES BEHAVIORAL SUPPORT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAYNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA ECHEVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-558-4018
Mailing Address - Street 1:175 FONTAINEBLEAU BLVD STE 2J1A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7017
Mailing Address - Country:US
Mailing Address - Phone:305-590-1085
Mailing Address - Fax:207-955-5251
Practice Address - Street 1:175 FONTAINEBLEAU BLVD STE 2J1A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7017
Practice Address - Country:US
Practice Address - Phone:305-590-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty