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General NPI Number Information
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NPI Number | 1578960480
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Entity Type | Organization
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Legal Business Name | CHANGES1, PLLC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 19940 CONANT STE A, B, & C
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City | DETROIT
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State | MI
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Zip | 48234-1494
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Country | US
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Telephone | 313-305-4180
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Fax | 313-733-8190
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Provider Business Mailing Address
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Address Line | 19940 CONANT STE A, B, & C
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City | DETROIT
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State | MI
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Zip | 48234-1494
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Country | US
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Telephone | 313-305-4180
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Fax | 313-733-8190
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MS. NAOMI DIANA TAYLOR
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Credential | LPN
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Telephone | 313-695-3951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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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 | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | SA0823228
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License Number State | MI
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