Healthcare Provider Details

I. General information

NPI: 1467783118
Provider Name (Legal Business Name): CHANGEPOINT INTEGRATED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 W COMMERCE PARK DR
LAKESIDE AZ
85929-5356
US

IV. Provider business mailing address

1801 W DEUCE OF CLUBS STE 100
SHOW LOW AZ
85901-2704
US

V. Phone/Fax

Practice location:
  • Phone: 928-368-4110
  • Fax: 928-368-4112
Mailing address:
  • Phone: 928-537-5315
  • Fax: 928-892-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HOYT
Title or Position: QM
Credential:
Phone: 928-537-5315