Provider Demographics
NPI:1174089569
Name:CHANGES PREMIER HEALTH , LLC
Entity type:Organization
Organization Name:CHANGES PREMIER HEALTH , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKET CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-428-0527
Mailing Address - Street 1:1820 N LAKE FOREST DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7653
Mailing Address - Country:US
Mailing Address - Phone:469-634-1270
Mailing Address - Fax:469-634-1271
Practice Address - Street 1:1820 N LAKE FOREST DR STE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7653
Practice Address - Country:US
Practice Address - Phone:469-634-1270
Practice Address - Fax:469-634-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health