Provider Demographics
NPI:1811533763
Name:READY FOR CHANGE
Entity type:Organization
Organization Name:READY FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-207-1565
Mailing Address - Street 1:510 SOUTH 10TH STREET
Mailing Address - Street 2:UNIT A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-7874
Mailing Address - Country:US
Mailing Address - Phone:702-462-6630
Mailing Address - Fax:
Practice Address - Street 1:510 SOUTH 10TH STREET
Practice Address - Street 2:UNIT A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-7874
Practice Address - Country:US
Practice Address - Phone:702-462-6630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366082471OtherINDIVIDUAL