Provider Demographics
NPI:1609399237
Name:A CHANGE FROM WITHIN, LLC
Entity Type:Organization
Organization Name:A CHANGE FROM WITHIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TANYIKIA
Authorized Official - Middle Name:SHARAY
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:215-806-9953
Mailing Address - Street 1:2991 W SCHOOL HOUSE LN APT OE14
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-5339
Mailing Address - Country:US
Mailing Address - Phone:215-806-9953
Mailing Address - Fax:
Practice Address - Street 1:1641 WIDENER PL
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1815
Practice Address - Country:US
Practice Address - Phone:215-806-9953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities