| Active Change Center | |
|
2498 N Stokesberry Pl. Suite 180 Meridian ID 83646 | |
| (208) 403-7488 | |
| (208) 529-1960 |
| Full Name | Active Change Center |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2498 N Stokesberry Pl., Meridian, Idaho |
| Authorized Official Name and Position | Danny Lee Rasco (BILLING AGENT) |
| Authorized Official Contact | 2082019513 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Change Center P.o. Box 409 Meridian ID 83680-0409 Ph: (208) 403-7488 | Active Change Center 2498 N Stokesberry Pl. Suite 180 Meridian ID 83646 Ph: (208) 403-7488 |
| NPI Number | 1497028161 |
|---|---|
| Provider Enumeration Date | 02/10/2012 |
| Last Update Date | 07/12/2022 |
| Certification Date | 07/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497028161 | NPI | - | NPPES |
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