Provider Demographics
NPI:1144429713
Name:CENTER FOR SOCIAL CHANGE INC
Entity Type:Organization
Organization Name:CENTER FOR SOCIAL CHANGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:TARAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-579-6789
Mailing Address - Street 1:6600 AMBERTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075
Mailing Address - Country:US
Mailing Address - Phone:410-579-6789
Mailing Address - Fax:410-796-1201
Practice Address - Street 1:3400 BARRY PAUL RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5161
Practice Address - Country:US
Practice Address - Phone:410-579-6789
Practice Address - Fax:410-796-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18031261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD286405300Medicaid