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Organization

CHANGING LIVES ADULT & YOUTH SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. SYDNEY BASKINS (CEO)
(301) 541-0963
Entity
Organization

Contact information

Practice address
9015 WOODYARD RD STE 109, CLINTON, MD 20735-4226
(240) 244-2924
(240) 244-5225
Mailing address
9015 WOODYARD RD STE 109, CLINTON, MD 20735-4226
(240) 244-2924
(240) 244-5225

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
1771
MD
251S00000X
Community/Behavioral Health Agency
Primary
1771
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1609320340
MD
05
1902241250
MD
Enumeration date
08/11/2016
Last updated
09/10/2019
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