Provider Demographics
NPI:1619407129
Name:CHANGE HEALTH SYSTEMS, INC
Entity Type:Organization
Organization Name:CHANGE HEALTH SYSTEMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OJO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:410-233-1088
Mailing Address - Street 1:2401 LIBERTY HEIGHTS AVE STE 4670
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-8032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 LIBERTY HEIGHTS AVE STE 4670
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-8032
Practice Address - Country:US
Practice Address - Phone:410-233-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANGE HEALTH SYSTEMS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-18
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children