Organization
CHANGEPOINT INTEGRATED HEALTH
Active
Other names
Woodland Home
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE HOSPODKA (CONTRACTING AND CREDENTIALING)
(928) 537-2951
Entity
Organization
Contact information
Practice address
447 S WOODLAND LN, PINETOP, AZ 85935-7139
(928) 537-2951
(928) 892-5828
Mailing address
1801 W DEUCE OF CLUBS STE 100, SHOW LOW, AZ 85901-2704
(928) 537-2951
(928) 892-5828
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
BH4759
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117138
—
AZ
Enumeration date
02/22/2016
Last updated
12/09/2016
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