Provider Demographics
NPI:1891268652
Name:HOUSE OF CHANGE BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:HOUSE OF CHANGE BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
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:410-323-3500
Mailing Address - Fax:410-323-3544
Practice Address - Street 1:1533 EDMONDSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1206
Practice Address - Country:US
Practice Address - Phone:410-323-3500
Practice Address - Fax:410-323-3544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF CHANGE BEHAVIORAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBH001446OtherBEHAV HEALTH LICENSE