1750801007 NPI number — CHANGE HEALTH SYSTEMS,INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750801007 NPI number — CHANGE HEALTH SYSTEMS,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANGE HEALTH SYSTEMS,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:
1750801007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 LIBERTY HEIGHTS AVE STE 4670
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21215-8032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-233-1088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 N POTOMAC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-4805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-420-1850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OJO
Authorized Official First Name:
ISRAEL
Authorized Official Middle Name:
OLAOLUWASUPO
Authorized Official Title or Position:
CEO/PROGRAM DIRECTOR
Authorized Official Telephone Number:
410-233-1088

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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