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NPI Code Detail

MEDICARE: PROJECT CHANGE CLUBHOUSE

MEDICARE: PROJECT CHANGE CLUBHOUSE
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1821328923
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROJECT CHANGE CLUBHOUSE
Provider Business Mailing Address
First Line : 2100 COMER AVE
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-8725
Country : US
Telephone Number : 706-596-5983
Fax Number : 706-596-5589
Provider Business Practice Location Address
First Line : 1727 BOXWOOD PL
Second Line :
City : COLUMBUS
State : GA
Zip : 31906-2328
Country : US
Telephone Number : 706-569-0727
Fax Number : 706-569-7324
Authorized Official
Title or Position : CEO
Name : PERRY ALEXANDER
Credential :
Telephone Number : 706-596-5757
Provider Enumeration Date : 01/12/2010
Last Update Date : 01/12/2010

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Directions to “PROJECT CHANGE CLUBHOUSE ” Practice Location

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