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General NPI Number Information
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NPI Number | 1013261569
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Entity Type | Organization
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Legal Business Name | CHANGE INSTITUTE RECOVERY CENTER
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 8888 W BELLFORT ST
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City | HOUSTON
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State | TX
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Zip | 77031-2406
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Country | US
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Telephone | 713-988-9673
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 710253
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City | HOUSTON
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State | TX
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Zip | 77271-0253
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Country | US
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Telephone | 713-988-9673
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LORETTA HENDERSON
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Credential | M.S.
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Telephone | 713-988-9673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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