Organization
CHANGE INC FAMILY MEDICAL CARE
Active
Other names
CHANGE INC
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA GRACE RAVEAUX (BILLING MANAGER)
(304) 748-2828
Entity
Organization
Contact information
Practice address
3136 WEST ST, WEIRTON, WV 26062-4637
(304) 748-2828
Mailing address
3136 WEST ST, WEIRTON, WV 26062-4637
(304) 748-2828
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810012462
—
WV
Enumeration date
09/04/2008
Last updated
09/04/2008
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