| Change Health Systems, Inc | |
|
2401 Liberty Heights Ave Suite 4670 Baltimore MD 21215-8019 | |
| (410) 233-1088 | |
| (410) 233-1087 |
| Full Name | Change Health Systems, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2401 Liberty Heights Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Israel Ojo (CEO) |
| Authorized Official Contact | 4102331088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Change Health Systems, Inc 2401 Liberty Heights Ave Suite 4670 Baltimore MD 21215-8019 Ph: (410) 233-1088 | Change Health Systems, Inc 2401 Liberty Heights Ave Suite 4670 Baltimore MD 21215-8019 Ph: (410) 233-1088 |
| NPI Number | 1558414862 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 09/27/2010 |
| Medicare PECOS PAC ID | 9335206465 |
|---|---|
| Medicare Enrollment ID | O20090317000486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558414862 | NPI | - | NPPES |
| 410166900 | Medicaid | MD | |
| 404096100 | Medicaid | MD | |
| 457980100 | Medicaid | MD | |
| 400314400 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 11925 (Maryland) | Primary |
| Provider Name | Bruce A Storms |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093722449 PECOS PAC ID: 4880620608 Enrollment ID: I20050713000519 |
| Provider Name | Olayinka S Oladimeji-stevens |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1104043637 PECOS PAC ID: 0042466146 Enrollment ID: I20120806000363 |
| Provider Name | Yvonne Etenyi Fomengia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215286810 PECOS PAC ID: 0840449872 Enrollment ID: I20121005000408 |
| Provider Name | Esther C Estwick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245449594 PECOS PAC ID: 4789871344 Enrollment ID: I20141126001274 |
| Provider Name | Bisrat A Mesfin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770992596 PECOS PAC ID: 7719209626 Enrollment ID: I20141204000360 |
| Provider Name | Lori A Close |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235535618 PECOS PAC ID: 6709109895 Enrollment ID: I20141222000842 |
| Provider Name | Sylivia U Acholonu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316336498 PECOS PAC ID: 1153635750 Enrollment ID: I20150804003096 |
| Provider Name | Melinda B Morgan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295070878 PECOS PAC ID: 0345550075 Enrollment ID: I20151110001209 |
| Provider Name | Michelle Ramirez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992101463 PECOS PAC ID: 7618233768 Enrollment ID: I20171107001023 |
| Provider Name | Taofeek A Bello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730603127 PECOS PAC ID: 2860758497 Enrollment ID: I20171114002280 |
| Provider Name | Kimberly Waibogha |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245567536 PECOS PAC ID: 9436298684 Enrollment ID: I20180530000749 |
| Provider Name | Wesley Lecounte |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386104156 PECOS PAC ID: 2961805403 Enrollment ID: I20210721003699 |
| Provider Name | Babatunde K Olujobi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912678244 PECOS PAC ID: 3971992595 Enrollment ID: I20211119000169 |
| Provider Name | Valerie T Marks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811148042 PECOS PAC ID: 5991852253 Enrollment ID: I20220630002188 |
| Provider Name | Kathleen J Adams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376657460 PECOS PAC ID: 6406886159 Enrollment ID: I20220630002785 |
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