Organization
THE CHANGE GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL EMILLIO CHATHAM SUDCC11 (ADMINISTRATOR)
(707) 695-2387
Entity
Organization
Contact information
Practice address
1636 JENNA PL, SANTA ROSA, CA 95403-8614
(707) 230-2180
(707) 230-2180
Mailing address
913 BRUNELLO DR, SANTA ROSA, CA 95407-6555
(707) 695-2387
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/10/2024
Last updated
04/10/2024
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