Provider Demographics
NPI:1730671827
Name:CHANGE PATH ONE, LLC
Entity Type:Organization
Organization Name:CHANGE PATH ONE, LLC
Other - Org Name:CHANGE PATH ONE HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEON
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLENOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-858-4043
Mailing Address - Street 1:14027 MEMORIAL DR # 419
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6826
Mailing Address - Country:US
Mailing Address - Phone:713-858-4043
Mailing Address - Fax:832-781-8766
Practice Address - Street 1:3922 CLUB VALLEY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-4139
Practice Address - Country:US
Practice Address - Phone:713-858-4043
Practice Address - Fax:832-781-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities