MEDICARE: CHANGE AGENTS OF SOCIAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LC1500X	Community Health Nurse Practitioner
2	171M00000X	Case Manager/Care Coordinator
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1780363044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGE AGENTS OF SOCIAL SERVICES LLC

Provider Business Mailing Address
First Line	:	2709 POSITIVE CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 POSITIVE CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0947
Country	:	US
Telephone Number	:	702-305-0652
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	CHRISTOPHER HANNIBLE
Credential	:
Telephone Number	:	702-305-0652

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	07/13/2023

Similar Medicare Providers

1750594271 — REGINA AGWU ARNP
Practice Location Address:

2716 W CENTRAL AVE
WICHITA, KS
67203-4904

Practice Phone: 316-660-7325
Practice Fax:

1679421945 — COMPASSIONATE CARE MEDICAL CENTER LLC
Practice Location Address:

408 VILLA ESPANA WAY
NORTH LAS VEGAS, NV
89031-2805

Practice Phone: 725-888-3000
Practice Fax:

1922947290 — CYNTHIA IRIS LOFQUIST
Practice Location Address:

1236 STONESTHROW CIR
NORTH LAS VEGAS, NV
89031-2356

Practice Phone: 702-715-6808
Practice Fax:

1013856269 — QANDEEL FATIMAH CHEVALWALA RBT
Practice Location Address:

5441 MAGIC MANGO ST
NORTH LAS VEGAS, NV
89031-7845

Practice Phone: 703-485-5511
Practice Fax:

1023965373 — CERA PAIGE LOPEZ NITAFAN
Practice Location Address:

2425 WINDY HILLS AVE
NORTH LAS VEGAS, NV
89031-4358

Practice Phone: 702-201-9678
Practice Fax:

1134877756 — MS. MARICRIS LORRAINE MARZO MSN, APRN, FNP-BC
Practice Location Address:

4755 W ANN RD
NORTH LAS VEGAS, NV
89031-3424

Practice Phone: 702-407-7063
Practice Fax:

Directions to “CHANGE AGENTS OF SOCIAL SERVICES LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.