Provider Demographics
NPI:1669055547
Name:AN OPPORTUNITY FOR CHANGE LLC
Entity type:Organization
Organization Name:AN OPPORTUNITY FOR CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BARBOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-469-7438
Mailing Address - Street 1:8307 PHILADELPHIA RD FL 2
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2961
Mailing Address - Country:US
Mailing Address - Phone:443-469-7438
Mailing Address - Fax:443-231-6265
Practice Address - Street 1:440 N LUZERNE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-1116
Practice Address - Country:US
Practice Address - Phone:443-469-7438
Practice Address - Fax:443-231-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility