NPIMap

Organization Active NPI

Changes

  • Community/Behavioral Health Agency
  • Palm Bay, FL
National Provider Identifier
1790116093
Registry record updated Dec 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CHANGES
Practice address
1156 Lamplighter Dr NW
Palm Bay, FL 32907-7936
Phone
(321) 591-3248
NPI assigned
Dec 11, 2013
Last updated
Dec 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2013

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

Authorized official

Name
Rolland Nicolas, MSWNPI 1629433867
Title
Clinician
Phone
(321) 591-3248

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X FL Primary

Addresses

Primary practice location

1156 Lamplighter Dr NW
Palm Bay, FL 32907-7936

Mailing address

1156 Lamplighter Dr NW
Palm Bay, FL 32907-7936
Phone (321) 591-3248

National Provider Directory

National Provider Directory
Tax ID family
Changes2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1386720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1790116093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1156 LAMPLIGHTER DR NW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329077936",
            "telephone_number": "321-591-3248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1156 LAMPLIGHTER DR NW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329077936",
            "telephone_number": "321-591-3248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-11",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "NICOLAS",
        "authorized_official_first_name": "ROLLAND",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "321-591-3248",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; 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.