Provider Demographics
NPI:1396189957
Name:CHANGEPOINT, LLC
Entity Type:Organization
Organization Name:CHANGEPOINT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ACADC
Authorized Official - Phone:208-413-2619
Mailing Address - Street 1:1020 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1842
Mailing Address - Country:US
Mailing Address - Phone:208-750-1000
Mailing Address - Fax:208-750-1009
Practice Address - Street 1:1020 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1842
Practice Address - Country:US
Practice Address - Phone:208-750-1000
Practice Address - Fax:208-750-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder