Organization
CHANGE INCORPORATED
Active
Parent organization
CHANGE INCORPORATED
Other names
FMC SBHC - Brooke Complex
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHANGE INCORPORATED
Authorized official
JUDY L RAVEAUX (CEO)
(304) 797-7733
Entity
Organization
Contact information
Practice address
29 BRUIN DR, WELLSBURG, WV 26070-3064
(047) 977-7333
Mailing address
3158 WEST ST, WEIRTON, WV 26062-4637
(130) 479-7773
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
2271-6959
WV
Other
Enumeration date
04/04/2018
Last updated
04/04/2018
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