| NPI | 1649798752 |
|---|---|
| Doing Business As | CHANGING LIVES OUTPATIENT CENTER |
| Entity Type | Organization |
| Authorized Contact | CORNELIUS TANYI Program Director 480-264-2647 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2017-09-08 |