Provider Demographics
NPI:1275896128
Name:ABOUT CHANGE
Entity Type:Organization
Organization Name:ABOUT CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NELGY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-737-5600
Mailing Address - Street 1:4833 TOMMANS TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-0760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13662 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2005
Practice Address - Country:US
Practice Address - Phone:919-737-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization