Provider Demographics
NPI:1699584649
Name:CHANGE AGENTS OF SOCIAL SERVICES
Entity type:Organization
Organization Name:CHANGE AGENTS OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:702-305-0652
Mailing Address - Street 1:9205 W RUSSELL RD STE 240
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1425
Mailing Address - Country:US
Mailing Address - Phone:702-305-0652
Mailing Address - Fax:
Practice Address - Street 1:9205 W RUSSELL RD STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1425
Practice Address - Country:US
Practice Address - Phone:702-305-0652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health