Provider Demographics
NPI:1689165029
Name:RL CHANGING LIVES ONE AT A TIME LLC
Entity Type:Organization
Organization Name:RL CHANGING LIVES ONE AT A TIME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-413-2371
Mailing Address - Street 1:115 KEY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3234
Mailing Address - Country:US
Mailing Address - Phone:443-413-2371
Mailing Address - Fax:
Practice Address - Street 1:4324 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4846
Practice Address - Country:US
Practice Address - Phone:410-243-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health