Provider Demographics
NPI:1700577012
Name:LIVING CHANGES LLC
Entity Type:Organization
Organization Name:LIVING CHANGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMKIN-BROCATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-517-8724
Mailing Address - Street 1:7476 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3542
Mailing Address - Country:US
Mailing Address - Phone:301-943-5207
Mailing Address - Fax:
Practice Address - Street 1:686 208TH ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1424
Practice Address - Country:US
Practice Address - Phone:301-943-5207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health