Provider Demographics
NPI:1194281303
Name:RAPID CHANGE CENTER, LLC
Entity type:Organization
Organization Name:RAPID CHANGE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:II
Authorized Official - Credentials:MS
Authorized Official - Phone:405-519-5243
Mailing Address - Street 1:423 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-2348
Mailing Address - Country:US
Mailing Address - Phone:405-519-5243
Mailing Address - Fax:
Practice Address - Street 1:716 S 10TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-5278
Practice Address - Country:US
Practice Address - Phone:405-519-5243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health