| Changing Lives At Home Mental Health Corporation | |
|
4805 Garrison Blvd 1st Floor And Suite 200 Baltimore MD 21215-5695 | |
| (443) 465-9523 | |
| (410) 510-1982 |
| Full Name | Changing Lives At Home Mental Health Corporation |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4805 Garrison Blvd, Baltimore, Maryland |
| Authorized Official Name and Position | Latrill Bryant-bass (CEO/DIRCTOR) |
| Authorized Official Contact | 4434639523 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Lives At Home Mental Health Corporation 202 Glenn Ellen Cir Pikesville MD 21208-1028 Ph: (443) 463-9523 | Changing Lives At Home Mental Health Corporation 4805 Garrison Blvd 1st Floor And Suite 200 Baltimore MD 21215-5695 Ph: (443) 465-9523 |
| NPI Number | 1912354184 |
|---|---|
| Provider Enumeration Date | 05/18/2016 |
| Last Update Date | 08/07/2024 |
| Certification Date | 08/07/2024 |
| Medicare PECOS PAC ID | 7719273788 |
|---|---|
| Medicare Enrollment ID | O20180221000330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912354184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Quinton G Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528411725 PECOS PAC ID: 4385922699 Enrollment ID: I20161020001284 |
| Provider Name | Barry Uzoechi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134874233 PECOS PAC ID: 6709252034 Enrollment ID: I20221012000195 |
| Provider Name | Finny Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235558024 PECOS PAC ID: 8426405481 Enrollment ID: I20231113002453 |
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