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General NPI Number Information
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NPI Number | 1063870392
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Entity Type | Organization
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Legal Business Name | MY CHANGE IS COMING, INC.
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Dates
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Enumeration Date | 02/01/2016
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Last Update Date | 02/01/2016
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Provider Practice Location Address
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Address Line | 319 BROOKWOOD DR
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City | DUNCANVILLE
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State | TX
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Zip | 75116-4504
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Country | US
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Telephone | 214-642-3146
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 380297
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City | DUNCANVILLE
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State | TX
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Zip | 75138-0297
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Country | US
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Telephone | 214-642-3146
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | AUDRY CATRICE HAYDEN
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Credential |
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Telephone | 214-642-3146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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