| Changes Place | |
|
258 N Phelps Ave Rockford IL 61108-2433 | |
| (815) 316-0699 | |
| (815) 316-0698 |
| Full Name | Changes Place |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 258 N Phelps Ave, Rockford, Illinois |
| Authorized Official Name and Position | Jack Phillips (ADMINISTRATOR) |
| Authorized Official Contact | 8153160699 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Changes Place 258 N Phelps Ave Rockford IL 61108-2433 Ph: (815) 316-0699 | Changes Place 258 N Phelps Ave Rockford IL 61108-2433 Ph: (815) 316-0699 |
| NPI Number | 1376707190 |
|---|---|
| Provider Enumeration Date | 07/10/2008 |
| Last Update Date | 07/10/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376707190 | NPI | - | NPPES |
| A47410001A | Other | IL | LICENSED OUTPATIENT SUBSTANCE ABUSE TREATMENT PROVIDER |
| A47410002A | Other | IL | LICENSED OUTPATIENT SUBSTANCE ABUSE TREATMENT PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | A47410002A (Illinois) | Primary |
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