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
Update your record
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