Provider Demographics
NPI:1467783118
Name:CHANGEPOINT INTEGRATED HEALTH
Entity Type:Organization
Organization Name:CHANGEPOINT INTEGRATED HEALTH
Other - Org Name:CHANGEPOINT PSYCHIATRIC HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:OAKES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:928-537-2951
Mailing Address - Street 1:1801 W DEUCE OF CLUBS STE 100
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-2704
Mailing Address - Country:US
Mailing Address - Phone:928-537-2951
Mailing Address - Fax:928-892-5828
Practice Address - Street 1:1920 COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-7004
Practice Address - Country:US
Practice Address - Phone:928-368-4110
Practice Address - Fax:928-368-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBHSH3489283Q00000X
AZSH4758284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ034027Medicare Oscar/Certification