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General NPI Number Information
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NPI Number | 1952716433
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Entity Type | Organization
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Legal Business Name | CHANGE INC
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 200 LURAY DR
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City | WINTERSVILLE
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State | OH
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Zip | 43953-3973
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Country | US
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Telephone | 740-314-8258
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Fax | 304-723-2195
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Provider Business Mailing Address
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Address Line | 3136 WEST ST
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City | WEIRTON
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State | WV
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Zip | 26062-4637
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Country | US
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Telephone | 304-797-7733
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Fax | 304-723-2195
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Authorized Official
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Title or Position | CEO
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Name | JUDY RAVEAUX
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Credential |
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Telephone | 304-797-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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