| Change Your Life Enterprises, Inc. | |
|
9505 W. Central Ste. 103 Wichita KS 67212-3832 | |
| (316) 721-0971 | |
| (316) 512-4070 |
| Full Name | Change Your Life Enterprises, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 9505 W. Central, Wichita, Kansas |
| Authorized Official Name and Position | Stephenie Ann Roberts (PRESIDENT/OWNER) |
| Authorized Official Contact | 3167210971 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Change Your Life Enterprises, Inc. 9505 W. Central Ste. 103 Wichita KS 67212-3832 Ph: (316) 721-0971 | Change Your Life Enterprises, Inc. 9505 W. Central Ste. 103 Wichita KS 67212-3832 Ph: (316) 721-0971 |
| NPI Number | 1003895988 |
|---|---|
| Provider Enumeration Date | 01/10/2006 |
| Last Update Date | 07/15/2011 |
| Medicare PECOS PAC ID | 7911929153 |
|---|---|
| Medicare Enrollment ID | O20051230000504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003895988 | NPI | - | NPPES |
| 565012 | Medicaid | KS |
| Provider Name | Stephenie Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083693956 PECOS PAC ID: 5294894192 Enrollment ID: I20081106000809 |
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