Provider Demographics
NPI:1750047338
Name:HOUSE OF CHANGE,INC.
Entity Type:Organization
Organization Name:HOUSE OF CHANGE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST / CREDENTIAL SPC
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-500-0712
Mailing Address - Street 1:5209 YORK RD STE B6
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4247
Mailing Address - Country:US
Mailing Address - Phone:410-366-3500
Mailing Address - Fax:
Practice Address - Street 1:1607 EDMONDSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1215
Practice Address - Country:US
Practice Address - Phone:410-366-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF CHANGE,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility