1831359603 NPI number — CHANGE HAPPENS, INC

Table of content: (NPI 1831359603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831359603 NPI number — CHANGE HAPPENS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANGE HAPPENS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831359603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 MARY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICOPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01020-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-536-1918
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 MARY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICOPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01020-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-536-1918
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SIMONE
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-536-1918

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1181 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 11795 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1036490 . This is a "BEACON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1036490 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 726247000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7282632 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1853171 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P08297 . This is a "BLUE CROSS / BLUE SHILED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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