Provider Demographics
NPI:1043762883
Name:CHANGING FACE INC
Entity Type:Organization
Organization Name:CHANGING FACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:COOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-937-5475
Mailing Address - Street 1:PO BOX 2452
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIE
Mailing Address - State:CA
Mailing Address - Zip Code:93457
Mailing Address - Country:US
Mailing Address - Phone:805-937-5475
Mailing Address - Fax:805-938-0129
Practice Address - Street 1:4124 ODIE LN
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-3109
Practice Address - Country:US
Practice Address - Phone:805-937-5475
Practice Address - Fax:805-937-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children