Provider Demographics
NPI:1992168413
Name:CHANGES PRIVATE RECOVERY LLC
Entity type:Organization
Organization Name:CHANGES PRIVATE RECOVERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRANATA
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:702-324-2532
Mailing Address - Street 1:177 ANGEL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5295
Mailing Address - Country:US
Mailing Address - Phone:512-667-1328
Mailing Address - Fax:
Practice Address - Street 1:177 ANGEL RIDGE LN
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5295
Practice Address - Country:US
Practice Address - Phone:512-667-1328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder