Organization
CHANGE, INCORPORATED
Active
Other names
FAMILY MEDICAL CARE Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY LYNN RAVEAUX (CHIEF EXECUTIVE OFFICER)
(304) 797-7733
Entity
Organization
Contact information
Practice address
3136 WEST ST, WEIRTON, WV 26062-4635
(304) 797-7733
Mailing address
3136 WEST ST, WEIRTON, WV 26062-4635
(304) 797-7733
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160961
CHANGE OH LICENSE
OH
01
—
2161000
CHANGE DBA FAMILY MEDICAL CARE CHC
OH
05
—
2733993
—
OH
01
—
361015
200 LURAY DRIVE WINTERSVILLE OH MEDICARE SITE #
OH
05
—
3810007536
—
WV
Enumeration date
07/27/2006
Last updated
10/30/2014
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