Provider Demographics
NPI:1568183713
Name:CHANGEPOINT INTEGRATED HEALTH
Entity Type:Organization
Organization Name:CHANGEPOINT INTEGRATED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-5315
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:928-532-5838
Mailing Address - Fax:928-892-5828
Practice Address - Street 1:2550 SHOW LOW LAKE ROAD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7929
Practice Address - Country:US
Practice Address - Phone:928-532-5838
Practice Address - Fax:928-892-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH7728Medicaid