LIFECHANGERS OUTREACH (NPI# 1790291334) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790291334 |
| Entity Type | Organization |
| Organization Name | LIFECHANGERS OUTREACH |
| Other Organization Name | LIFECHANGERS IOP |
| Practice Address |
2450 Winfield Dunn Pkwy Kodak TN 37764-2100 |
| Mailing Address |
404 Holly Ct Sevierville TN 37862-5314 |
| Practice Telephone | 8658050567 |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2018-09-25 |
| Authorized Official Name | MATTHEW JOHNSON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8658050567 |
| Authorized Official Credential | M.A., M.DIV |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
1000000021300 | TN | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| LifeChangers IOP | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3677 Robert C. Byrd Drive, Beckley, WV 25801 | 8658050567 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | LIFECHANGERS OUTREACH | 202 Sugar Hollow Rd, Pigeon Forge, TN 37863-3271 |
| Street Address |
2450 WINFIELD DUNN PKWY |
| City | KODAK |
| State | TN |
| Zip Code | 37764-2100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487081758 | Tn Premier Care LLC | Clinic/Center | 3609 Outdoor Sportsman Pl Ste 7, Kodak, TN 37764 | 2013-10-02 |
| 1326306861 | Benjamin Michael Blanton | Nurse Practitioner | 946 Winfield Dunn Parkway, Suite 107, Kodak, TN 37764 | 2012-05-02 |
| 1477677474 | Eugene Woody Stinson | Dentist | 2946 Winfield Dunn Pkwy, Ste #301, Kodak, TN 37764 | 2007-03-17 |
| 1144719808 | Tn Premier Care LLC | Durable Medical Equipment & Medical Supplies | 3609 Outdoor Sportsman Pl Ste 7, Kodak, TN 37764 | 2018-05-08 |
| 1861828816 | Benjamin Joseph Wittman | Physical Therapist | 2946 Winfield Dunn Pkwy Ste 106, Kodak, TN 37764 | 2013-09-23 |
| 1902078587 | Roger Dale Barnes | Registered Nurse | 2946 Winfield Dunn Parkway, Suite 107, Kodak, TN 37764 | 2008-03-24 |
| 1912914219 | Tiffinie A. Allen-evans | Dentist | 9618 Gunnies Dr, Kodak, TN 37764-1107 | 2006-08-01 |
| 1922565225 | Karen Lynn Lester | Nurse Practitioner | 3651 Winfield Dunn Pkwy, Kodak, TN 37764-1471 | 2019-02-23 |
| 1194282491 | Deborah Clay Sellers-mooney | Nurse Practitioner | 3651 Winfield Dunn Pkwy, Kodak, TN 37764-1471 | 2019-02-23 |
| 1164069084 | Premier Care Medical | Clinic/Center | 3609 Outdoor Sportsman Pl Ste 7, Kodak, TN 37764-1477 | 2019-12-10 |
| Find all providers in zip 37764 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346850708 | Crossroads Treatment Centers of Tennessee, PC | Clinic/Center | 114 Perkins Ln, Jacksboro, TN 37757-2833 | 2020-07-31 |
| 1477161982 | Addiction Behavioral Care | Clinic/Center | 2617 Grandview Ave Ste 103, Nashville, TN 37211-2263 | 2020-07-21 |
| 1841808342 | Nashville Addiction Clinic | Clinic/Center | 5515 Edmondson Pike Ste 118, Nashville, TN 37211-5871 | 2020-07-21 |
| 1043828668 | Chattanooga Recovery Center LLC | Clinic/Center | 13 W Kent St Ste 201, Chattanooga, TN 37405-9913 | 2020-07-20 |
| 1588296131 | Integrative Health Centers LLC | Clinic/Center | 1105 16th Ave S Ste C, Nashville, TN 37212-2327 | 2020-02-11 |
| 1912465121 | Applegate Health Services of Tennessee, Inc | Clinic/Center | 446 Metroplex Dr Ste 200a, Nashville, TN 37211-3139 | 2019-03-06 |
| 1295204022 | Harpeth Recovery Clinic | Clinic/Center | 3011 Harrah Dr Ste T, Spring Hill, TN 37174-6254 | 2018-11-22 |
| 1861984353 | The Transition House of Tennessee, Inc. | Clinic/Center | 1024 E Mlk, Chattanooga, TN 37403-2710 | 2018-05-31 |
| 1265923775 | Wake Up Well Recovery LLC | Clinic/Center | 211 Donelson Pike Ste 108, Nashville, TN 37214-2929 | 2018-05-21 |
| 1275049215 | Holston Health Associates, Pllc | Clinic/Center | 249 E Main St Ste A, Johnson City, TN 37604-5707 | 2017-12-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.