| Change Inc | |
|
114 Taylor Ave Weirton WV 26062-4635 | |
| (304) 748-2828 | |
| Not Available |
| Full Name | Change Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 114 Taylor Ave, Weirton, West Virginia |
| Authorized Official Name and Position | Judy L Raveaux (CEO) |
| Authorized Official Contact | 3047977733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Change Inc 3158 West St Weirton WV 26062-4637 Ph: (304) 797-1210 | Change Inc 114 Taylor Ave Weirton WV 26062-4635 Ph: (304) 748-2828 |
| NPI Number | 1619503422 |
|---|---|
| Provider Enumeration Date | 03/13/2020 |
| Last Update Date | 03/13/2020 |
| Certification Date | 03/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619503422 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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