NPIMap

Organization Active NPI

Power for Change, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Green Bay, WI
National Provider Identifier
1124322284
Registry record updated Nov 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
POWER FOR CHANGE, LLC
Practice address
123 N Oakland Ave
Green Bay, WI 54303-2831
Phone
(920) 770-4088
Fax
(920) 496-7922
NPI assigned
Jan 4, 2011
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Steve Anthony Shefchik, MA, LPC, NCCNPI 1265613095
Title
Clinical Director
Phone
(920) 770-4088

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 43

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20161223000022 WI Part B Supplier - Clinic/Group Practice 0840571253 Receives reassigned benefits from 4 practitioners
Practice locations: Green Bay, WI

National Provider Directory

National Provider Directory

Locations

123 N Oakland Ave
Green Bay, WI 54303
Phone (920) 770-4088

2448 S 102nd St
Ste 155
West Allis, WI 53227
Phone (414) 541-5100

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

NPPES NPI Registry

Primary practice location

123 N Oakland Ave
Green Bay, WI 54303-2831

Mailing address

123 N Oakland Ave
Green Bay, WI 54303-2831
Phone (920) 770-4088

Other practice location 1

2448 S 102nd St Ste 155
West Allis, WI 53227-2147
Phone (414) 541-5100

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
100013205MedicaidWI

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 16, 2021.

{
    "created_epoch": "1294099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637020800000",
    "number": "1124322284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 N OAKLAND AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032831",
            "telephone_number": "920-770-4088",
            "fax_number": "651-705-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 N OAKLAND AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032831",
            "telephone_number": "920-770-4088",
            "fax_number": "920-496-7922"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2448 S 102nd St Ste 155",
            "address_purpose": "LOCATION",
            "city": "West Allis",
            "state": "WI",
            "postal_code": "532272147",
            "country_code": "US",
            "telephone_number": "414-541-5100",
            "fax_number": "884-515-9455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "POWER FOR CHANGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-04",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "SHEFCHIK",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "920-770-4088",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, LPC, NCC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100013205",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.