Basic Information
| Provider Information | |||||||||
| NPI: | 1174089569 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHANGES PREMIER HEALTH , LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1820 N LAKE FOREST DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750717653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696341270 | ||||||||
| FaxNumber: | 4696341271 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 N LAKE FOREST DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750717653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696341270 | ||||||||
| FaxNumber: | 4696341271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2019 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | CASTLE | ||||||||
| AuthorizedOfficialFirstName: | SAMANTHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MARKET CEO | ||||||||
| AuthorizedOfficialTelephone: | 9724280527 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.