| Changing Lives At Home Sud,inc | |
|
4805 Garrison Blvd 1st Floor And Suite 200 Baltimore MD 21215-5695 | |
| (443) 869-2600 | |
| (410) 510-1982 |
| Full Name | Changing Lives At Home Sud,inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4805 Garrison Blvd, Baltimore, Maryland |
| Authorized Official Name and Position | Latrill Bryant-bass (CEO/DIRECTOR) |
| Authorized Official Contact | 4434639523 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Lives At Home Sud,inc 202 Glenn Ellen Cir Pikesville MD 21208-1028 Ph: (443) 463-9523 | Changing Lives At Home Sud,inc 4805 Garrison Blvd 1st Floor And Suite 200 Baltimore MD 21215-5695 Ph: (443) 869-2600 |
| NPI Number | 1124705546 |
|---|---|
| Provider Enumeration Date | 06/28/2023 |
| Last Update Date | 06/30/2023 |
| Certification Date | 06/30/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124705546 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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