Provider Demographics
NPI:1598452948
Name:CHANGE SERVICES LLC
Entity Type:Organization
Organization Name:CHANGE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:PEG
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-401-0419
Mailing Address - Street 1:1700 BROADWAY AVE N
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4144
Mailing Address - Country:US
Mailing Address - Phone:612-749-0227
Mailing Address - Fax:
Practice Address - Street 1:1700 BROADWAY AVE N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4144
Practice Address - Country:US
Practice Address - Phone:612-749-0227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit