Provider Demographics
NPI:1639778392
Name:NATIONAL INSTITUTE FOR CHANGE, P.C.
Entity Type:Organization
Organization Name:NATIONAL INSTITUTE FOR CHANGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KEELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-231-0090
Mailing Address - Street 1:3225 S WADSWORTH BLVD UNIT T
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5009
Mailing Address - Country:US
Mailing Address - Phone:303-231-0090
Mailing Address - Fax:
Practice Address - Street 1:1827 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1724
Practice Address - Country:US
Practice Address - Phone:303-231-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL INSTITUTE FOR CHANGE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)