Changes Place

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

A47410002A Issued in IL

Legal business name

CHANGES PLACE

Practice address

258 N Phelps Ave
Rockford, IL 61108-2433

Phone

(815) 316-0699

Fax

(815) 316-0698

NPI assigned

Jul 10, 2008

Last updated

Jul 10, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jack Phillips, CADC

Title

Administrator

Phone

(815) 316-0699

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1376707190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 N PHELPS AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082433",
            "telephone_number": "815-316-0699",
            "fax_number": "815-316-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 N PHELPS AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082433",
            "telephone_number": "815-316-0699",
            "fax_number": "815-316-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGES PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-10",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "815-316-0699",
        "authorized_official_credential": "CADC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "A47410002A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED OUTPATIENT SUBSTANCE ABUSE TREATMENT PROVIDER",
            "identifier": "A47410001A",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED OUTPATIENT SUBSTANCE ABUSE TREATMENT PROVIDER",
            "identifier": "A47410002A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amaan Chalisa
• Danielle Challenger, LPN, CNA
• Daniel F Chamberlain, MD
• Meredith Chance, LCSW
• Nisha Chandran, MD
• Judy Chanthalangsy, O.D.
• Viengkeo Chanthaloth- Phasouk, LCSW
• Logan John Chapman-Neal
• Heather Chapman
• Charles R. Welford MD SC

• Community/Behavioral Health Agency in Rockford, IL
• Providers in Rockford, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; 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.