Provider Demographics
NPI: | 1356044150 |
---|---|
Name: | CHANGEPOINT INTEGRATED HEALTH |
Entity type: | Organization |
Organization Name: | CHANGEPOINT INTEGRATED HEALTH |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JEFF |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | OAKES |
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: | 520-428-1900 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2931 HWY 260 |
Practice Address - Street 2: | |
Practice Address - City: | OVERGAARD |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85933-8590 |
Practice Address - Country: | US |
Practice Address - Phone: | 928-965-2832 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CHANGEPOINT INTEGRATED HEALTH |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-03-22 |
Last Update Date: | 2025-06-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |