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General NPI Number Information
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NPI Number | 1598452948
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Entity Type | Organization
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Legal Business Name | CHANGE SERVICES LLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 1700 BROADWAY AVE N
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City | ROCHESTER
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State | MN
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Zip | 55906-4144
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Country | US
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Telephone | 612-749-0227
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 BROADWAY AVE N
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City | ROCHESTER
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State | MN
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Zip | 55906-4144
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Country | US
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Telephone | 612-749-0227
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | PEG KINDA
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Credential |
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Telephone | 507-401-0419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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