Organization
CHANGE AGENTS OF SOCIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER HANNIBLE (CHIEF EXECUTIVE OFFICER)
(702) 305-0652
Entity
Organization
Contact information
Practice address
2709 POSITIVE CT, NORTH LAS VEGAS, NV 89031-0947
(702) 305-0652
Mailing address
2709 POSITIVE CT, NORTH LAS VEGAS, NV 89031-0947
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363LC1500X
Community Health Nurse Practitioner
—
—
Other
Enumeration date
07/13/2023
Last updated
07/13/2023
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