Provider Demographics
NPI:1770233934
Name:TRANSFORMING YOUTHS INTO ADULTS
Entity Type:Organization
Organization Name:TRANSFORMING YOUTHS INTO ADULTS
Other - Org Name:T.Y.I.A-LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KAREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:443-208-2645
Mailing Address - Street 1:518 N CHARLES ST 2ND FL REAR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5053
Mailing Address - Country:US
Mailing Address - Phone:443-208-2645
Mailing Address - Fax:
Practice Address - Street 1:518 N CHARLES ST 2ND FL REAR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5053
Practice Address - Country:US
Practice Address - Phone:443-208-2645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD83-2393436Medicaid