Organization
CHANGE INC
Active
Other names
FMC SBHC
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY RAVEAUX (CEO)
(304) 797-7733
Entity
Organization
Contact information
Practice address
3248 PENNSYLVANIA AVE, WEIRTON, WV 26062-3804
(304) 748-2828
Mailing address
3248 PENNSYLVANIA AVE, WEIRTON, WV 26062-3804
(304) 748-2828
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/19/2014
Last updated
06/19/2014
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