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General NPI Number Information
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NPI Number | 1265186001
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Entity Type | Organization
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Legal Business Name | THE CHANGE AGENCY
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 2400 W STROOP RD
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City | MORAINE
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State | OH
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Zip | 45439-2041
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Country | US
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Telephone | 937-877-7155
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 W STROOP RD
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City | MORAINE
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State | OH
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Zip | 45439-2041
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Country | US
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Telephone | 937-877-7155
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Fax |
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Authorized Official
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Title or Position | CASE MANAGEMENT SUPPORT
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Name | SHAWNDIA R WILSON
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Credential |
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Telephone | 937-877-7155
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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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