Healthcare Provider Details

I. General information

NPI: 1720619356
Provider Name (Legal Business Name): CHANGE AGENT NETWORK AFRICA,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2020
Last Update Date: 02/02/2020
Certification Date: 02/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 SIPPLE AVE
BALTIMORE MD
21206-5605
US

IV. Provider business mailing address

4801 SIPPLE AVE
BALTIMORE MD
21206-5605
US

V. Phone/Fax

Practice location:
  • Phone: 240-524-0636
  • Fax:
Mailing address:
  • Phone: 240-524-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILE D. ASHWOOD
Title or Position: PROGRAM MANAGER
Credential: MED/EDUCATIONA
Phone: 240-524-0636