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Organization
CHANGING LIVES ADULT & YOUTH SERVICES
Active
Organization
CHANGING LIVES ADULT & YOUTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SYDNEY BASKINS B.A. (CEO)
(301) 541-0963
Entity
Organization
Contact information
Practice address
4810 SAINT BARNABAS RD STE 203, TEMPLE HILLS, MD 20748-4604
(202) 431-5576
Mailing address
4810 SAINT BARNABAS RD STE 203, TEMPLE HILLS, MD 20748-4604
(301) 541-0963
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609320340
—
MD
05
—
1902241250
—
MD
Enumeration date
04/30/2013
Last updated
09/10/2019
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