Provider Demographics
NPI:1457502205
Name:NATIONAL INSTITUTE FOR CHANGE, P.C.
Entity Type:Organization
Organization Name:NATIONAL INSTITUTE FOR CHANGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIPPE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARQUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:303-231-0090
Mailing Address - Street 1:3225 S WADSWORTH BLVD
Mailing Address - Street 2:UNIT T
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227
Mailing Address - Country:US
Mailing Address - Phone:303-231-0090
Mailing Address - Fax:303-231-0992
Practice Address - Street 1:3225 S WADSWORTH BLVD
Practice Address - Street 2:UNIT T
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227
Practice Address - Country:US
Practice Address - Phone:303-231-0090
Practice Address - Fax:303-231-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health