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RWII28470 Life Changers Intervention Services LLC (Active)
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Main Details
Name
Life Changers Intervention Services LLC
Subdivision Name
Type
Ryan White Part B
340B ID
RWII28470
Grant Number
X07HA00051
Additional Details
Current Program Status
Active
Registration Date
7/1/2022
Participating Start Date
7/21/2022
Participating Approval Date
7/20/2022
Last Recertification Date
2/10/2025
Time Period the Assistance was Received
4/1/2022 - 3/31/2027
Contacts
Authorizing Official
Life Changers Intervention Services
Beverly Stanley, CEO/Executive Director
(910) 754-7988
Primary Contact
Life Changers Intervention Services
Melissa Stanley Brown, Lead Case Manager
(910) 754-7988
Addresses
Street Address
5039 Main Street
Suite 2
Shallotte, NC 28470
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date: (1/1/2014) until terminated effective date: (04/1/2022), reinstatement effective date: (07/15/2022) 4/1/2022
07/15/2022
May 2025
May 2025
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