NPIMap

Organization Active NPI

Change Incorporated

Doing business as FMC SBHC - Brooke Complex

  • Federally Qualified Health Center (FQHC)
  • Wellsburg, WV
National Provider Identifier
1063918472
Registry record updated Apr 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
2271-6959 Issued in WV
Legal business name
CHANGE INCORPORATED
Doing business as
FMC SBHC - Brooke Complex
Practice address
29 Bruin Dr
Wellsburg, WV 26070-3064
Phone
(047) 977-7333
NPI assigned
Apr 4, 2018
Last updated
Apr 4, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
CHANGE INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judy L Raveaux
Title
Ceo
Phone
(304) 797-7733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 2271-6959 WV Primary

Addresses

Primary practice location

29 Bruin Dr
Wellsburg, WV 26070-3064

Mailing address

3158 West St
Weirton, WV 26062-4637
Phone (130) 479-7773

Other names 1

  • FMC SBHC - Brooke Complex Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Change Incorporated8 organizations share this tax ID, including this one
Part of
Change Incorporated

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

29 Bruin Dr
Wellsburg, WV 26070
Phone (304) 527-1410

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522800000000",
    "number": "1063918472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3158 WEST ST",
            "city": "WEIRTON",
            "state": "WV",
            "postal_code": "260624637",
            "telephone_number": "130-479-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 BRUIN DR",
            "city": "WELLSBURG",
            "state": "WV",
            "postal_code": "260703064",
            "telephone_number": "047-977-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGE INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHANGE INCORPORATED",
        "enumeration_date": "2018-04-04",
        "last_updated": "2018-04-04",
        "status": "A",
        "authorized_official_last_name": "RAVEAUX",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-797-7733"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "2271-6959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FMC SBHC - Brooke Complex",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellsburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.