Organization
CHANGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY L RAVEAUX (CEO)
(304) 797-7733
Entity
Organization
Contact information
Practice address
114 TAYLOR AVE, WEIRTON, WV 26062-4635
(304) 748-2828
Mailing address
3158 WEST ST, WEIRTON, WV 26062-4637
(304) 797-1210
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
03/13/2020
Last updated
03/13/2020
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