Provider Demographics
NPI:1689212508
Name:CHANGEPOINT INTEGRATED HEALTH
Entity Type:Organization
Organization Name:CHANGEPOINT INTEGRATED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSPODKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-2951
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:928-537-2951
Mailing Address - Fax:
Practice Address - Street 1:1500 S WHITE MOUNTAIN RD BLDG 3
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7111
Practice Address - Country:US
Practice Address - Phone:928-537-2951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANGEPOINT INTEGRATED HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)