Provider Demographics
NPI:1053703124
Name:CHANGE HOMEHEALTH
Entity type:Organization
Organization Name:CHANGE HOMEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IVORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-668-6583
Mailing Address - Street 1:3220 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60104-2232
Mailing Address - Country:US
Mailing Address - Phone:708-668-6583
Mailing Address - Fax:708-544-5677
Practice Address - Street 1:3220 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-2232
Practice Address - Country:US
Practice Address - Phone:708-668-6583
Practice Address - Fax:708-544-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD14138856251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health