Provider Demographics
NPI:1629098132
Name:CHANGE, INC
Entity Type:Organization
Organization Name:CHANGE, INC
Other - Org Name:FAMILY MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-797-7733
Mailing Address - Street 1:3032 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062
Mailing Address - Country:US
Mailing Address - Phone:304-748-2828
Mailing Address - Fax:304-797-0002
Practice Address - Street 1:3032 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-748-2828
Practice Address - Fax:304-797-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV-001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty