Organization
THE CHANGE AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWNDIA R WILSON (CASE MANAGEMENT SUPPORT)
(937) 877-7155
Entity
Organization
Contact information
Practice address
2400 W STROOP RD, MORAINE, OH 45439-2041
(937) 877-7155
Mailing address
2400 W STROOP RD, MORAINE, OH 45439-2041
(937) 877-7155
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0428294
—
OH
Enumeration date
02/10/2022
Last updated
02/10/2022
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