Healthcare Provider Details

I. General information

NPI: 1669702312
Provider Name (Legal Business Name): CHANGE HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 N POTOMAC ST
HAGERSTOWN MD
21740-4805
US

IV. Provider business mailing address

7 N POTOMAC ST
HAGERSTOWN MD
21740-4805
US

V. Phone/Fax

Practice location:
  • Phone: 240-420-1850
  • Fax: 240-420-1852
Mailing address:
  • Phone: 240-420-1850
  • Fax: 240-420-1852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number4408
License Number StateMD

VIII. Authorized Official

Name: ISRAEL OJO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 410-233-1088