Organization
CHANGE INC
Active
Other names
Family Medical Care CHC
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY RAVEAUX (CEO)
(304) 797-7733
Entity
Organization
Contact information
Practice address
200 LURAY DR, WINTERSVILLE, OH 43953-3973
(740) 314-8258
(304) 723-2195
Mailing address
3136 WEST ST, WEIRTON, WV 26062-4637
(304) 797-7733
(304) 723-2195
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810025567
—
WV
Enumeration date
06/24/2014
Last updated
11/07/2014
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