Provider Demographics
NPI:1295431450
Name:CHANGING LANES RECOVERY, INC
Entity type:Organization
Organization Name:CHANGING LANES RECOVERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GISHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:808-419-0446
Mailing Address - Street 1:6425 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3501
Mailing Address - Country:US
Mailing Address - Phone:520-367-5255
Mailing Address - Fax:520-372-8313
Practice Address - Street 1:6425 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3501
Practice Address - Country:US
Practice Address - Phone:520-367-5255
Practice Address - Fax:520-372-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit